An insightful webinar exploring the power of collaboration between providers and health plans to achieve accurate risk-adjusted compensation. While providers and health plans may have different perspectives, there are numerous synergies and opportunities to use data analytics and drive value for patients. We delve into how providers
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Join us for an insightful webinar exploring the power of collaboration between providers and health plans to achieve accurate risk-adjusted compensation. While providers and health plans may have different perspectives, there are numerous synergies and opportunities to use data analytics and drive value for patients. We’ll delve
Read More →– by Jocelyn Bayliss, Program Lead, Provider Network Management & Tina Gallagher, Market Manager, Provider Network Management In April 2023, CMS issued a final rule that added two new specialty types, clinical psychology and clinical social work, to network adequacy standards. Addition of Specialty Types and Amendments
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In this webinar, we discuss the critical role providers play in the success of improved health outcomes, Star ratings, HEDIS measures and risk adjustment. We dive into: – What provider organizations should know about the latest trends in Star ratings, HEDIS measures and risk adjustment – Risk
Read More →Per the CY 2023 Final Rule published on May 9, 2022, CMS requires applicants to demonstrate a sufficient network of contracted providers to care for beneficiaries before approving their application. Additionally, for CY 2024, CMS adopted regulations explicitly stating that applications may be denied if network adequacy
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The proposed rule, Ensuring Access to Medicaid Services, includes changes to existing requirements and introduces new requirements. The proposed regulations advance CMS’s efforts to improve access to care, quality and health outcomes; the regulations are intended to promote health equity across fee-for-service (FFS) and managed care delivery
Read More →CMS requires applicants to demonstrate they have a sufficient network of contracted providers before an initial or service-area expansion application is approved. In addition, for CY 2024, CMS will adopt regulations explicitly permitting it to deny applications based on an applicant’s failure to meet network adequacy criteria. Plans
Read More →CMS released the Medicare Program; Contract Year 2024 Policy and Technical Changes to the Medicare Advantage Program, Medicare Prescription Drug Benefit Program, Medicare Cost Plan Program, Medicare Parts A, B, C, and D Overpayment Provisions of the Affordable Care Act and Programs of All-Inclusive Care for the
Read More →A multi-state Medicaid plan faced a competitive bid for contract renewal. The state is moving to mandatory managed Medicaid for its standard Medicaid population as well as dual-eligible and long-term services and supports’ enrollees who need home- and community-based services. It was a substantial rebid with a
Read More →The Centers for Medicare & Medicaid Services (CMS) requires that all health plans have written standards for access to care timeliness and member services. Your health plan is required to: Most states have a standard set requirement for primary and specialty care access and availability. Is your
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