CMS Changes the Network Adequacy Application Process for Medicare Advantage Organizations
The Centers for Medicare & Medicaid Services (CMS) unveiled changes to the network adequacy application process for Medicare Advantage (MA) organizations. Whether you’re involved in compliance, market expansion, provider recruitment, or network management, these updates are crucial. Let’s break down these changes to help you understand the new process. CMS Network Adequacy Reviews for Initial […]
Mark Your Calendars: Important Medicare-Medicaid Plan Network Submission Coming Up
Managing a Medicare-Medicaid Plan (MMP) provider network is no small feat, and deadlines can sneak up on you quickly. To ensure you stay ahead, we’re here to provide all the essential details you need to know for the upcoming network submission. Network Submission Due Date Reminder Key Dates and Times Let’s dive straight into the […]
QHP Certification and Network Adequacy Review Timeline
Who doesn’t love a good calendar? We know we do. Whether you’re deep into network adequacy updates or juggling deadlines left and right, we’ve got your back. Our handy calendar lays out the crucial submission dates for Qualified Health Plan (QHP) issuers on Federally-facilitated Exchanges. As a bonus, we’ll keep it updated for you! Go ahead and […]
Network Adequacy and Provider Directory Accuracy Policy Updates
Now that 2024 is fully underway, we’d like to bring you up to speed on the network adequacy and provider directory policy updates that emerged between December 2023 and February 2024. Federal Policy Updates CMS Issues Request for Information on Medicare Advantage Data The Centers for Medicare & Medicaid Services (CMS) opened the year with […]
CMS Corrective Action Plans: What Medicare Advantage Organizations Need to Know
The Centers for Medicare & Medicaid Services (CMS) turned things up a notch with new provider directory requirements last year, and now they’re doubling down with Corrective Action Plan requests for Medicare Advantage (MA) Organizations that aren’t playing by the rules. We’re breaking down the latest news about the added provider directory requirements and Corrective […]
The Requiring Enhanced & Accurate Lists of Health Providers Act
Are enrollees receiving the healthcare services they were promised? Inaccurate provider directories and ghost networks have been longstanding concerns in the healthcare industry, particularly with mental health services. Recognizing the need for improvement, lawmakers have introduced new legislation to address inaccurate data and help seniors receive the care they purchased. The Requiring Enhanced & Accurate Lists […]
What You Need to Know About QHP Certification
Staying on top of all the latest updates in the industry can be a real challenge. That’s why we’re here to break down everything you need to know about the Qualified Health Plan (QHP) certification and network adequacy compliance. Grab your favorite beverage and get ready to dive into the world of QHP certification and […]
Four Ways Regulators Prioritize Health Equity into Network Adequacy
In the pursuit of high-quality healthcare, it is essential to go beyond network adequacy metrics and prioritize health equity. In a conversation between Scott Westover, SVP of Network and Regulatory Strategy at Quest Analytics, Michael Conway, Colorado Insurance Commissioner, and Grace Arnold, Minnesota Department of Commerce Commissioner, we learned how these leaders are working together […]
Predictions On The Proposed 2024 Exchange Rule – Part 3
https://www.youtube.com/watch?v=zp0aVnW2mxs What health policy trends are we watching? Let’s discuss! The third part of our latest Regulatory Review is here! Zach Snyder and Kate Deiters explore the different ways states are making the connection between health equity and network adequacy. REGULATORY REVIEW Predictions on the Proposed 2024 Exchange Rule Zach Snyder and Kate Deiters of […]
Predictions On The Proposed 2024 Exchange Rule – Part 1
Zach Snyder and Kate Deiters of Quest Analytics are here to discuss the upcoming Proposed Exchange Rule for 2024. They share predictions for what may appear in the proposed rule—including telehealth, wait times, and health equity. The Exchange Rule, also known as the Notice of Benefit and Payment Parameters (NBPP), is an annual rule that […]
