Estimated read time: 3-4 minutes
This archived news story is available only for your personal, non-commercial use. Information in the story may be outdated or superseded by additional information. Reading or replaying the story in its archived form does not constitute a republication of the story.
[STK]
[IN] HEA MTC STW
[SU]
TO BUSINESS, HEALTH, AND TECHNOLOGY EDITORS:
Quest Analytics Expands Network Adequacy to Give States an Automated
Review Process
APPLETON, Wis., Feb. 26, 2014 /PRNewswire/ -- Quest Analytics, leaders
in delivering network adequacy solutions to the healthcare market, has
expanded their industry leading desktop solutions to support an
automated network adequacy solution for state and federal reporting
requirements. This integrated solution provides both States and
Federal Agencies the ability to qualify and monitor plans for network
adequacy and ongoing compliance with the current and future
standards.
Pursuant to 45 C.F.R. 156.230(a)(2), an issuer of a QHP that has a provider network must maintain a network that is sufficient in number and types of providers, including providers that specialize in mental health and substance abuse disorder services, to assure that all services will be accessible to enrollees without unreasonable delay. All issuers applying for QHP certification will need to attest that they meet this standard as part of the certification/recertification process.
For the 2015 benefit year, issuers will be required to submit a provider list that includes all in-network providers and facilities for all plans for which a QHP certification application is submitted. Unlike the certification process for benefit year 2014, CMS will no longer utilize issuer accreditation status, identify states with review processes at least as stringent as those identified in 45 C.F.R. 156.230(a), or collect network access plans as part of its evaluation of plans' network adequacy. Rather, CMS will review the collected provider list to evaluate provider networks using a "reasonable access" review standard, and will identify networks that fail to provide access without unreasonable delay as required by 45 C.F.R. 156.230(a)(2). In order to determine whether an issuer meets the "reasonable access" standard, CMS will focus most closely on those areas which have historically raised network adequacy concerns.1
Quest Analytics has been supporting this same reporting process for
Medicare Advantage plan qualification. "By evolving the Quest
Analytics SuiteT we have expanded the technology with more flexibility
to adapt to any federal or state based network adequacy reporting
requirements", says John P. Weis, Co-founder of Quest Analytics.
Further John adds, "Why would you work with older tools that were
designed for one purpose, when you can utilize the Quest Analytics
SuiteT to meet multiple needs?" The Quest Analytics SuiteT solution
allows network adequacy requirements to be managed through a
self-service environment. It introduces efficiency and agility to the
old self-reporting models, thus, meeting new proposed requirements for
the Health Insurance Marketplace. The Quest Analytics SuiteT can
eliminate much of the heavy lifting of network adequacy validation,
and it empowers regulators with the information needed to qualify
plans. The process is simple, yet extremely powerful and can either
be hosted internally or externally depending on resource
requirements.
David H. Hill and John P. Weis founded Quest Analytics in 2003. Quest
Analytics is an independent solutions company, built without ties to
any health plan. Both Hill and Weis have extensive experience in
commercial software development and consulting services for the
healthcare industry. Their experience in the industry has brought many
innovative solutions to the market ranging from; pioneering access
analysis and disruption analysis tools, to evolving network adequacy
solutions and right-sized network design services. Today, Quest
Analytics' dedication to provide innovative solutions to challenges
facing the healthcare industry continues, as their industry expertise
is sought on a national basis. For more information, please contact us
at 920.739.4552 or visit us at www.QuestAnalytics.com.
1
Contact: Linda Borths National Sales Director Email Phone:
920.739.4552
Read more news from Quest Analytics.
SOURCE Quest Analytics
-0- 02/26/2014
/Web Site: http://www.questanalytics.com
CO: Quest Analytics
ST: Wisconsin
IN: HEA MTC STW
PRN
-- PH72192 --
0000 02/26/2014 13:30:00 EDT http://www.prnewswire.com
Copyright © The Associated Press. All rights reserved. This material may not be published, broadcast, rewritten or redistributed.
