Medicare Advantage Resources
NEW PROPOSED RULE FOR MEDICARE ADVANTAGE ORGANIZATIONS
Your Medicare Advantage Application Toolkit
ACE YOUR MEDICARE ADVANTAGE NETWORK ADEQUACY APPLICATION
Preparing for your Medicare Advantage Application? Below are our legislative brief, blog post and videos to help you be review-ready and compliant-confident.
Inside Edition
REVIEW OF THE MA FINAL RULE
CMS reinstates network adequacy reviews as a condition of initial or expanding service area applications. Our own Zach Snyder breaks down the changes to give you astonishing clarity on what’s new.
Strategies for Success
New Rules, No Problem
The Medicare Advantage Final Rule changed the way Medicare Advantage Organizations apply for Initial or Service Area Expansion applications. James Lamb, VP of National Payers, is here to share the 4 key things to you need to know before you apply.
Strategies for Success
Discover Your Opportunity, Network Build and ROI
When you’re preparing to expand your Medicare Advantage Provider Network footprint, it’s important to understand the costs and potential ROI of adding new counties. In this video, Eliza Hoffman, VP of Regional Payers, shares how she and her team can help you understand the network build effort to expand into each desired county, the potential ROI upon achieving average enrollment, and which providers to contract with to quickly and efficiently fill specialty gaps. Schedule your Complimentary Opportunity Analysis today!
Inside Edition
THE STATE OF PROVIDER NETWORK OVERSIGHT
To get a sense of what’s on the horizon for Medicare Advantage Organizations, we need to look at the entire healthcare policy landscape—and then plan accordingly. Scott Westover and Michael Adelberg shed light on the additional factors that CMS considers when addressing Medicare Advantage oversight.
Strategies for Success
WHAT TO DO WHEN YOUR MEDICARE ADVANTAGE CONTRACT IS IN JEOPARDY
Discovering network deficiencies after submitting your HSD table to CMS can be stressful. Where should you start if you want to quickly add providers to the network? Eliza Hoffman, our VP of Regional Payers Segment, shares the answer.
On-Demand Webinar
UNDERSTANDING THE NETWORK ADEQUACY CHANGES IN THE MA FINAL RULE
Join Scott Westover and Michael Adelberg for a special presentation on the new Medicare Advantage Application requirements and how you can stay ahead of the curve.
Strategies for Success
WHY KNOWING WHICH PROVIDERS ARE LISTED AT MULTIPLE LOCATIONS IS CRUCIAL TO CMS COMPLIANCE
Paula Partin, our Senior Director of Quest Enterprise Services Adequacy, reminds us why knowing which providers are listed at multiple locations—sooner rather than later—is key to avoiding costly errors.
Strategies for Success
How Provider Network Management Teams Position Themselves for Success
As health plans evolve to keep pace with today’s ever-changing requirements, Provider Network Management teams must adapt their data management strategies to support provider data accuracy, transparency, and automation. Eliza Hoffman, VP of Regional Payers, shares our top strategies for maintaining a thriving – and compliant provider network.
MEASURE YOUR NETWORK LIKE CMS
Ready to evaluate your provider network the same way that regulators will evaluate it? Quest Analytics delivers the answers to your test – bringing peace of mind by showing you what regulators will see when they evaluate your network. Our Medicare Advantage and Medicare-Medicaid Network Adequacy templates will reduce your compliance testing time and cost, leaving you with more time to focus on getting better insight into your data and taking action where it matters.
Blog
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.
But what does this mean for you? Here’s the inside scoop on what’s going on in the industry right now, what changes are coming down the pike and how to maximize your chances of success.
Regulatory Review of the Medicare Advantage Final Rule
CMS reinstates network adequacy reviews as a condition of initial or expanding service area applications. Our own Zach Snyder breaks down the changes to give you astonishing clarity on what’s new.
BUILD A BEST-IN-CLASS PROVIDER DATA MANAGEMENT STRATEGY
Health plans need to create scalable environments in order to remain competitive. With the right strategy and tools, they can improve data workflow across their organization, avoid data silos & bottlenecks, and grow their provider networks efficiently. Here are the five key factors successful health plans use to improve their process for provider data integration, provider network management, and data quality assurance.
CMS Changes Network Adequacy Application Process for Medicare Advantage
The Centers for Medicare and Medicaid Services (CMS) is tightening network adequacy oversight again—this time for Medicare Advantage organizations. If you’re involved with compliance, market expansion or provider recruitment, we’ve broken down how the change impacts you.
Expand Your Footprint
When it comes to your expansion, you need tools that make it easier and faster for you to make the right decisions. You want to know which providers can add the most value to your network and where to focus your efforts for the most gain. Quest Enterprise Services helps you do just that!
Provider Data Management Tips for CMS Compliance
Network Adequacy Applications, Submissions, Reviews and More
Best Practices Infographic
Steps to Take for a Successful Network Submission
Streamline Your Network Adequacy Exceptions
EXPEDITE YOUR PROCESS. ENHANCE YOUR EXCEPTION NARRATIVE.
Getting a network adequacy exception request accepted is no walk in the park. This can be true whether you’re submitting to the Centers for Medicare & Medicaid Services (CMS) or a State Regulator. The Quest Enterprise Services Exceptions Package automates and simplifies your network adequacy exception request process for CMS or the State, leaving you with more time to focus on other priorities.
On-Demand Webinar
The ROI of Provider Network Management
Hear how a New York health plan uses Quest Enterprise Services to quickly and efficiently identify the right providers to fill gaps, leverage deeper data insights to optimize contract negotiations with providers, improve internal communication, and streamline the process for submitting HSD Exception Requests.
Smart Stats Infographic
How Inaccurate Provider Data Impacts Network Adequacy
NETWORK ADEQUACY TEMPLATES
Quest Analytics has pre-built templates based on the standards & requirements for Medicare Advantage, Medicaid-Medicare, and an ever-growing list of state Medicaid programs. See which templates are available for you today!
Strategies for Success
What To Do When Your Medicare Advantage Contract Is In Jeopardy
Discovering network deficiencies after submitting your HSD table to CMS can be stressful. Where should you start if you want to quickly add providers to the network? Eliza Hoffman, our VP of Regional Payers Segment, shares the answer.
Strategies for Success
How Provider Network Management Teams Position Themselves for Success
As health plans evolve to keep pace with today’s ever-changing requirements, Provider Network Management teams must adapt their data management strategies to support provider data accuracy, transparency, and automation. Eliza Hoffman, VP of Regional Payers, shares our top strategies for maintaining a thriving – and compliant provider network.
Press Release
CMS EXTENDS ITS CONTRACT WITH QUEST ANALYTICS
The Centers for Medicare & Medicaid Services (CMS) has extended their contract with Quest Analytics for an additional five-year term to measure the adequacy of all Medicare Advantage Part C & D and Medicare-Medicaid Health Plans’ (MMP) provider, facility and pharmacy networks.
SCHEDULE YOUR COMPLIMENTARY NETWORK ASSESSMENT
Interested in discovering how we can assist you with your service area expansion and network adequacy goals? Schedule your complimentary network assessment with a Quest Analytics expert today.