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 […]
Medicare Advantage: Latest Network Adequacy Application Insights
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. Overview of Network Adequacy Changes for […]
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 […]
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 […]
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 […]
CMS Request For Information on Strengthening Medicare Advantage
RESOURCE CENTER FOR HEALTH PLAN REGULATORS AND POLICYMAKERS Welcome to a space designed for federal and state regulators, insurance commissioners, and health policymakers at all levels to drive conversations around ensuring timely and appropriate access to care. Join our conversations!
Biden Administration Releases Final Surprise Billing Rule
Surprise Billing Final Rule The White House announced on Friday a final rule updating the arbitration process that insurers and providers can use to settle out-of-network billing disputes. Following several legal setbacks, the newly released final rules implement the No Surprises Act, which protects consumers from unexpected medical bills. The final rules, released by the […]
