The Model Documents released by CMS each year offer instructional guidance and standardized document templates for the member materials that must be distributed each fall by Medicare Advantage, Medicare Advantage Prescription Drug, […]
“Regulations do have their role. They’re very important to assuring patient safety and quality and for program integrity, but there’s a fine line between being helpful and being a hindrance,” […]
The Centers for Medicare and Medicaid Services (CMS) requires plans to monitor and conduct regular updates of their provider network data, including updating providers’ ability to accept new patients, as […]
September 30th has long passed, but now is the time to reflect on your ANOC/EOC fulfillment processes in order to implement new efficiencies for next year. As a full-service member […]
From the 11 million Premera members to the 80 million Anthem consumers effected by a cyber attack, security breaches are on the rise in healthcare and insurers are just as […]
Finalized on November 22, 2015 after 18 months of discussion, the National Association of Insurance Commissioners (NAIC) approved an updated version of its Managed Care Plan Network Adequacy Model Act. […]
Pre-2016 Medicare Advantage network adequacy guidance simply states that plans must maintain a network of providers “sufficient to provide adequate access to covered services to meet the needs of the […]
The 2017 Final Call Letter to Medicare Advantage Organizations (MAOs) continued to emphasize the importance of provider directory accuracy and the increased monitoring and enforcement actions to commence due to […]
Beginning January 1, 2016, CMS will be strengthening their benchmarks for provider network data. This is due to a year plagued with consumer complaints regarding misleading provider network data in […]