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 […]
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 […]
Federal Medicaid Network Adequacy Standards
BASIC MCO QUANTITATIVE NETWORK ADEQUACY STANDARDS OVERVIEW This Basic Overview is an overview of what is required of States under current federal regulations.3 At a minimum, a State must develop a quantitative network adequacy standard for the following provider types, if covered under the MCO contract: Primary care, adult and pediatric OB/GYN Behavioral health (mental health and […]
No Surprises Act Provider Directory Enforcement Guidance for Regulators
Section 116 of the No Surprises Act (NSA) requires health plans to establish a provider directory verification process and a procedure for removing providers or facilities with unverifiable information. No less than once every 90 days, health plans must verify and update their provider directory database. Within 2 business days of receiving a provider update, […]
What is Provider Data Validation – Are You in Compliance?
WHAT IS PROVIDER DATA VALIDATION? Provider data validation (sometimes referred to as provider data verification or attestation) is a process where health plans confirm each participating provider’s contact and other information displayed in the public provider directory is correct or incorrect. The goal is to update and maintain their provider data to prevent incorrect provider […]
CMS Proposed Rule for CY 2023 Medicare Advantage and Part D
AMEND MA NETWORK ADEQUACY RULES BY REQUIRING A COMPLIANT NETWORK AT APPLICATION Could we be looking at the reinstatement of network adequacy reviews as a condition of initial or service area applications? Possibly. The rule proposes that Medicare Advantage (MA) plan applicants demonstrate they meet the network adequacy requirements for the pending service area before CMS will approve an […]
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 […]
