The Growing Need for Accurate Provider Data

The Growing Focus on Accurate Provider Data

Gather around healthcare enthusiasts! The focus on accurate provider data is heating up and we have the inside scoop. From federal and state regulations to health policymakers, the buzz is gaining momentum. Keep reading to stay in the know.  Current Activity to Ensure Accurate Provider Data What Provider Data Accuracy Rules are in place? Let’s […]

CMS Changes Network Adequacy Application Process for Medicare Advantage

Medicare Advantage Organization Network Adequacy Rules for the Application Credit and Letters of Intent

NEW CMS NETWORK ADEQUACY REQUIREMENTS Demonstrate Adequate At the Time of Application 10-percentage Point Application Credit Letter of Intent to Contract CMS REINSTATES NETWORK ADEQUACY REVIEWS AS A CONDITION OF INITIAL OR EXPANDING SERVICE AREA APPLICATIONS Starting with the 2024 contract year (CY 2024) application cycle, Medicare Advantage organizations (MAOs) applying for an initial or […]

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 Services (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 […]

Overview of the Proposed Notice of Benefit and Payment Parameters for 2023 Rule

While the proposed rule touches on a range of topics, we invite health plans to pay special attention to the proposed provisions that apply to issuers offering Qualified Health Plans (QHPs) through the Federally-facilitated Exchanges (FFE) and State-based Exchanges on the Federal platform (SBE-FP) beginning plan year 2023. The rule proposes that CMS, not individual states, […]

Improving Network Adequacy and Access For Mental Health

Federal and state policymakers are taking a variety of measures to improve access to mental health services and substance use disorder treatments. Network adequacy and access are prominent areas of such a response directly affecting health plans. This blog post informs stakeholders about the increased emphasis on behavioral health networks and tips on how to […]

FAQs and Provider Directory Requirements: Key Tips and Targets

One of the top questions health insurers have asked us lately is: Will I still need to have a provider directory verification process in place by January 1, 2022? Simply put, yes. In this blog, we’re highlighting the essential points you need to know about the FAQs and provider directory requirements. FAQS ABOUT THE PROVIDER DIRECTORY REQUIREMENTS […]

New Guidance on Provider Directory Verification Requirements Stands Firm on January 1, 2022, Effective Date

In a new guidance document that provided plans and issuers with some enforcement delays over key new price transparency requirements, the Biden administration stood firm on new provider directory verification requirements effective January 1, 2022. BACKGROUND As discussed in a prior post from Quest Analytics, starting on January 1, 2022, section 116 of the Consolidated Appropriations […]

CMS to Regulate Qualified Health Plan (QHP) Network Adequacy

Starting Plan Year 2023, the Centers for Medicare & Medicaid Services (CMS) is responsible for imposing the regulations for the Qualified Health Plan (QHP) certification process, including network adequacy standards and reviews. This change was affirmed in the second final rule, HHS Notice of Benefit and Payment Parameters (also known as “2022 Payment Notice”). Specifically, changing […]

Federal Update: Requirements Related to Surprise Billing; Part 1

On July 1, the Biden administration released an interim final rule with comment period (IFC), “Requirements Related to Surprise Billing; Part I.” This is the first significant step to implementing the No Surprises Act, passed as part of the Consolidated Appropriations Act of 2021 (CAA) in December 2020. The No Surprises Act protects healthcare consumers, […]