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 prime a target as hospitals and physician offices. According to a 2017 Accenture survey of 2,000 U.S. consumers, one in four have had their personal […]
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. Renamed the Network Adequacy Model Act, the name has been intentionally broadened to expand the applicability and scope of the Act to all network plans […]
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 population served” and establish written rules on timeliness of access to care in accordance with CMS standards. Of course, this ambiguity has led to numerous […]
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 preliminary data collected via the PNA Pilot Program that found severe violations with the Part D and Part C requirements. CMS stated, however, that they […]
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 addition to CMS audits that have uncovered massive errors rates in provider directory resources. A series of high-profile health plan lawsuits have further brought attention […]