By Jocelyn Bayliss, Senior Vice President, Provider Network Management and Ashleigh Majdeski, Vice President, Provider Network Operations & Performance When a surveyor calls a provider listed as in-network and the number doesn’t work, that provider goes unevaluated. That isn’t a neutral outcome. It’s a provider who may
Read More →By Tina Gallagher, Network Strategy & Development Program Lead, ATTAC Consulting Group I just returned from the 15th Medicare Stars, HEDIS®, Quality & Risk Summit, and one theme ran through nearly every session I attended: the conversation around provider access has fundamentally changed. It wasn’t coming from one presenter or one
Read More →Section 6220 of the Consolidated Appropriations Act, 2026, also known as the REAL Health Providers Act, is already signed into law. CMS and ONC held a public stakeholder meeting on it this month and are now collecting written comments directly by email, with new Medicare Advantage provider
Read More →CMS recently released updated operational guidance for Contract Year (CY) 2027 Medicare Advantage (MA) applications. This guidance introduces pivotal shifts in how organizations manage network adequacy and exception requests, meaning the “old way” of managing deficiencies is no longer sufficient for those preparing for the February submission.
Read More →In the Contract Year 2027 Proposed Rule (CMS-4212-P), CMS introduced significant changes to how provider network changes are handled, which will directly impact health plan operations and enrollment stability. For health plan leaders, the headline is clear: the proposed changes remove historical guardrails around network stability, potentially
Read More →As we close out 2025, the first year of mandatory secret shopper surveys under the CMS Final Rule is behind us. With the 2026 cycle starting on January 1, now is the time to apply the hard-won lessons from the inaugural reporting year. Reviewing the 2025 Access
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CMS Finalizes Medicare Plan Finder 2027 Rule: What Health Plans Need to Know In one of the most consequential transparency updates in recent years, CMS has finalized new requirements that will make Medicare Advantage (MA) provider directories publicly available on Medicare Plan Finder beginning with plan year 2027. This change marks a
Read More →The Centers for Medicare & Medicaid Services (CMS) has officially released the Contract Year (CY) 2027 Notice of Intent to Apply (NOIA) for Medicare Advantage (MA) and Part D plans. Health plans preparing for new or expanded contracts should act quickly: several critical submission deadlines fall between
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In the 2025 Final Rule, CMS released its expectations and reporting requirements to ensure timely access to care. By the second Friday in June each year, issuers that offer Qualified Health Plans (QHPs)—including stand-alone dental plans—in the federally-facilitated exchanges or the federally-facilitated Small Business Health Options Programs
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The new administration brings opportunities and challenges for the healthcare industry. While final regulatory guidance has not yet been released, health plans and providers will need to respond quickly when changes are finalized. An agile strategy, with the ability to rapidly deploy an expert workforce, is critical.
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