The Growing Need for 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 […]
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 2
Will Qualified Health Plans on the Federally-facilitated Marketplace see Appointment Wait Times added as a network adequacy requirement? Let’s discuss it! In Part 2 of our Regulatory Review, Zach Snyder and Kate Deiters continue to share our predictions for the proposed Notice of Benefit and Payment Parameters rule for 2024. https://www.youtube.com/watch?v=mH2jvCK9kGE APPOINTMENT WAIT TIMES AND […]
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 […]
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 […]
