Provider Data Accuracy Resource Hub

New Health Policy Episode

Get ready for 2025 with the latest insights on major health policy changes! Join Kate Deiters and Zach Snyder as they break down federal policy updates related to network adequacy and provider directory accuracy. Discover what’s changing and how you can start preparing for the new requirements.

  • The Propose 2026 Notice of Benefit and Payment Parameters
  • Managed Care Final Rule
  • Mental Health Parity and Addiction Equity Act (MHPAEA) Final Rule
  • CMS National Directory Pilot
  • Trends for 2025

Explore Our Latest Articles

CMS Releases Proposed Rule Impacting Medicare Advantage Organizations for Contract Year 2026
On December 10, 2024, the Centers for Medicare & Medicaid Services (CMS) released a proposed rule impacting Medicare Advantage (MA) Organizations for Contract Year 2026. This proposal introduces pivotal provisions...
FAQs: Medicare Advantage Applications and Letters of Intent
Medicare Advantage (MA) Organizations applying for initial, or service area expansion can use Letters of Intent in place of a signed contract to help meet network adequacy requirements while going...
Health Policy Trends Across Markets
Health policy is a dynamic field, continually evolving to improve the healthcare industry. As regulators and stakeholders push for higher standards, several key trends are emerging across markets that aim...

Featured Downloables

Provider Directory Accuracy Workbook
No Surprises Act Provider Directory Accuracy Planning Worksheet Get Your Provider Directory Ready for the No Surprise Act and Beyond If you’re like most of our clients, you’re working hard...
The Guide for Accurate Provider Directories
The Guide To Provider Data Accuracy Download Now! Provider Data Management Tips And so it begins, the new era for provider directories. From roles & responsibilities to proven strategies to...
How to Comply with Provider Directory Rules
How to Comply with the Provider Directory Verification Requirements No Surprises Act Requirements The No Surprises Act has brought a new level of scrutiny to health plans. Now, it’s not...

Featured Articles on Ghost Networks

Ghost Networks in Healthcare: What They Are and How To Address Them
Ghost networks have increasingly become a central topic in discussions within the healthcare sector and legislative circles. As this issue gains attention, it is crucial to understand the implications of...
How Ghost Networks Impact Health Plans and Health Systems
Health plans and health systems face significant financial challenges due to the presence of ghost providers. Keeping these providers in your data undermines the efficacy of health systems, resulting in...
Tips to Avoid the Ghost Network Trap
Ghost Networks are a significant challenge in the healthcare industry. By adopting a standard operating procedure that helps you understand which providers are truly clinically active, you can increase the...
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...

Provider Data Management Tips to Successfully Meet the No Surprises Act

Health plans must have a documented, defendable process in place to show the effort they’re making to comply with the provider directory verification requirements. What should this process look like? We have the answer! 

FAQs and Provider Directory Requirements: Key Tips and Targets

We answer the most frequently asked question that health plans are asking us regarding the CAA Provider Directory Requirements. We also share tips and targets to help you get ahead in the coming months.

The Hottest Trends across health insurance markets

The data is in—and it’s clear: provider network oversight, provider data accuracy and provider data transparency are the hot trends across all health insurance markets. Find out what this means for you.

On-Demand Webinar: AHIP & Quest Analytics Present

STAY AHEAD OF NEW PROVIDER DIRECTORY REQUIREMENTS

Quest Analytics partnered with AHIP to continue the conversation about the new Provider Directory Verification requirements listed in the No Surprises Act. Watch now and learn about:

  • The new provider directory accuracy requirements for health plans and providers
  • The impact the requirements have on your business
  • Which strategies to implement now

Access On-Demand Webinar

On-Demand Webinar

No Surprises Act: What You Need to Know and Why

The No Surprises Act includes regulations that will affect most of our health plan clients. As many are just learning about the new provider data requirements, we want to share the cliff notes and answer the most common questions. Watch the on-demand webinar to learn best practices, strategies, and actionable steps you can take today to align with the new federal requirements.

The New Provider Directory Accuracy Mandate

Under the No Surprises Act, commercial, qualified health plans (QHPs), and employer-based health plans are required to maintain accurate provider directories. Read our legislative brief to learn about the new requirements that health plans and providers need to meet.

White Paper

Surprises in the No Surprises Act for Health Plans and Providers

The new provider directory verification requirements continue to surprise most health plans and providers. Discover what each party needs to do to update the provider directory, and how to design your process to comply with the accuracy requirements.

Best Practices

Implementation In Four Phases

There is a lot to consider and accomplish as you prepare for the mandate. Where do you begin? What happens next? What is a realistic timeline? We’ve mapped out the process for you. Download the Four Phases of Implementing a Provider Data Verification process.

Best Practices

Eleven Questions to Ask Your Teams

As a best practice when preparing for the Provider Data and Directory Verification mandate, it is imperative that you understand your current process. Download the top eleven questions we recommend you ask your teams

Best Practices

Frequently Asked Questions

Section 116: Protecting Patients and Improving the Accuracy of the Provider Directory Information, requires health plans and providers to work together to maintain up-to-date provider directories. Discover the answers to the top questions about the new requirements.

LEARN MORE WITH RELATED RESOURCES

Insights Article

TRANSPARENCY IN COVERAGE

Insights Article

TRANSPARENCY IN COVERAGE

Schedule Your Complimentary Strategy Session

Compliance isn’t our name, but it sure is our game! Learn how we can assist your efforts to make your provider data accurate and network adequate. Book a complimentary strategy session with a Quest Analytics expert to get started on your quest for success.

 

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