Provider Networks

Latest Headlines

Latest Headlines

5 ways to improve provider directories

With hundreds of thousands of dollars in fines, millions of dollars in customer rebates and customer loyalty at risk, payers can no longer afford to manage inaccurate or inadequate provider directories, according to a new report.

Are sick beneficiaries better off in traditional Medicare?

Despite the popularity of Medicare Advantage plans, research has called into question whether they serve sicker beneficiaries as well as those who are healthy, according to a post for the  New York Times' The Upshot. 

In past eight months, 15K MA enrollees granted special enrollment periods

Federal officials have allowed more than 15,000 Medicare Advantage members to use special enrollment periods to change plans or join traditional Medicare in the last eight months because of "significant" provider cuts in their plans' networks.

CMS plans network-breadth rating system for Healthcare.gov plans

Though the federal government has stepped back from its proposal to implement additional network adequacy regulations for Affordable Care Act plans, it will move forward with its initiative to provide Healthcare.gov shoppers with information about health plans' network breadth.  

3 ways payers can adapt to meet consumer expectations

With consumerism now a game-changing reality in the healthcare industry, payers must align their business strategies to focus on their customers as both members and patients, according to a new report from IDC Health Insights.

AHIP: Out-of-network bills vary greatly nationwide

The amount providers bill consumers for out-of-network care varies greatly from state to state,  according to an analysis from America's Health Insurance Plans, findings the group says underscore the value of health plans' provider networks.   

Provider networks can help members obtain specialty care

Insurers' provider networks can help patients obtain safe and affordable specialty care when they include a range of specialty doctor and hospital groups with a history of delivering high quality care, according to a new report from America's Health Insurance Plans.

3 key reasons CMS overhauled MCO rule

Although insurers have already begun pushing back against proposed Medicaid managed care organization regulations, the Centers for Medicare & Medicaid Services released the rule so that it could catch existing regulation up with reality.

Use of tiered networks prompts hospitals to cut prices

Hospitals now operate in a world of increasingly narrow provider networks and tiered preferences. How do those elements impact their bottom line? They take a fairly significant bite, according to a recent study conducted by Harvard University on behalf of the Commonwealth Fund.

CMS tightens provider directory rules for 2016

Starting next year, health insurers must provide up-to-date doctor lists for their  Medicare Advantage and Healthcare.gov policies, according to the Centers for Medicare & Medicaid Services.