Medicare Advantage Network Applications: What You Need to Know for CY 2027
If you’re gearing up for the Contract Year (CY) 2027 Medicare Advantage (MA) application process, this is your guide. Whether it’s understanding key dates, staying ahead of new network adequacy standards, or perfecting your submission, we’ve got insights to help you succeed. Let’s dive in and make sure you’re fully prepared. Key CY 2027 Application […]
The Requiring Enhanced & Accurate Lists of Health Providers Act
Accurate provider directories are essential to ensuring enrollees can access the care they need and deserve. Leading healthcare advocates echo this sentiment, which serves as the foundation for the proposed Requiring Enhanced and Accurate Lists of Health Providers Act (REAL Health Providers Act). Inaccurate provider directories and the prevalence of “ghost networks” have posed serious […]
What Is Provider Data Validation and Why It Matters for Health Plans
When was the last time you relied on your provider network data? Was it to prepare for a regulatory submission? Evaluate network performance? Update provider directories? Or maybe to decide whether to continue offering a specific product? No matter the reason, one factor was likely central to your outcome: provider data accuracy. Accurate and up-to-date […]
Network Adequacy and Provider Directory Accuracy Policy Updates
Federal and state regulators, along with lawmakers, are actively amending network adequacy and provider directory accuracy requirements while intensifying oversight. These changes have far-reaching implications for medical and ancillary plans. Understanding the key developments and emerging trends is essential for stakeholders to ensure strategic alignment and maintain compliance. Get the Executive Summary Medicare Advantage Medicare […]
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 […]
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 network adequacy requirements for plan year 2026. QHP Application and Network Adequacy Requirements Every year, the Department of Health and […]
New Features to Improve Compliance with Federal Regulations
OVERLAND PARK, KS (June 30, 2022) – Quest Analytics, the leader in provider network management solutions and services, today introduced three new features for Quest Enterprise ServicesTM (QES) designed to improve their client’s ability to address the No Surprises Act (NSA), QHP Certification and the evolving provider network regulations. The new offerings include: Accuracy API & Daily Refresh: With the No Surprises Act […]
Quest Analytics to Measure Adequate Access to Care for Medicare Advantage, Medicare-Medicaid and Pharmacy Plans
OVERLAND PARK, KS, September 15, 2020 – Quest Analytics, the leader in provider network accuracy and adequacy solutions announced today the Centers for Medicare & Medicaid Services (CMS) has extended their contract with Quest Analytics for an additional five-year term to measure the adequacy of all Medicare Advantage Part C & D and Medicare-Medicaid Health Plans’ (MMP) provider, […]
