The Hidden Costs of Not Having Accurate Provider Data & How to Solve It
You’ve probably heard the buzz surrounding provider data accuracy, and you might be wondering just how important it is for your organization. Well, you’re not alone! We conducted a study to uncover the hidden costs of not having accurate provider data. Buckle up, because we’re about to share some eye-opening insights with you. Download the […]
How Ghost Networks Impact Health Plans and Health Systems
As a health plan or health system, you want to provide the best possible care for your patients. Unfortunately, ghost providers can make this goal difficult to achieve. These non-active providers can harm both patients and your business in numerous ways. Here are five ways ghost networks can cost you, from disrupting access to patient […]
Network Adequacy and Provider Directory Accuracy Policy Updates
Now that 2024 is fully underway, we’d like to bring you up to speed on the network adequacy and provider directory policy updates that emerged between December 2023 and February 2024. Federal Policy Updates CMS Issues Request for Information on Medicare Advantage Data The Centers for Medicare & Medicaid Services (CMS) opened the year with […]
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 […]
How to Increase Practitioner Response Rates for Data Accuracy
Identifying effective strategies to engage healthcare practitioners is crucial for insurers and decision-makers. By improving response rates from practitioners, you can gather valuable insights and enhance your decision-making processes. In this blog, we will explore three proven strategies that can help you increase practitioner engagement and boost your practitioner response rates. https://youtu.be/gdetAGKa2wk?si=LZLCjBylPVD5U41j How to Simplify […]
Key Metrics for Provider Directory Audits: Provider Outreach Analytics
If you want to pass a provider directory audit, looking at your provider outreach analytics is a great place to start. With the right analytics, you can demonstrate compliance and improve provider data accuracy. In this article, we’ll walk you through the must-have metrics to help you stay on the right side of compliance and […]
Frequently Asked Questions & Answers: Medicare Advantage Applications and Letters of Intent
Medicare Advantage 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 through the application process. The intention is to give applicants seeking to expand into a new market the opportunity to reach the threshold for network adequacy […]
CMS Changes the Network Adequacy Application Process for Medicare Advantage Organizations
If you’re involved with compliance, market expansion, or provider recruitment for a Medicare Advantage (MA) Organization, listen up! As organizations seek to either enter the Medicare Advantage market or expand their service areas, understanding these changes is paramount to achieving compliance and securing approval. Network Adequacy Reviews for Initial or Service Area Expansion Applications MA […]
Network Adequacy and Provider Directory Accuracy Policy Updates
What’s the latest news on network adequacy and provider directory accuracy? Here’s what took place in November. Download Article Federal Policy Updates Proposed Rule: 2025 Medicare Advantage Program New Mental Health Facility-Specialty Type and Network Adequacy Exceptions The Centers for Medicare & Medicaid Services (CMS) proposed changes to the Medicare Advantage program for the contract […]
Network Adequacy and Provider Directory Accuracy Policy Updates
Looking for the latest updates on network adequacy and provider directory health policies? You’ve come to the right place. Let’s dive into the latest federal and state policy developments. Download Article Federal Policy Updates Regulators and policymakers are dedicated to strengthening the oversight process for Medicare Advantage, Marketplace, and Medicaid Health Plans, both at the […]
