Services

Retium Health assists organizations that participate in the Medicare Advantage program. Our services include support with the provider network submission and review process to ensure that networks meet CMS adequacy criteria. We also help with the development of exception requests and provide additional consulting services for MA organizations.

Formal Network Review

Initial applications and SAEs are reviewed by CMS in June. We can help plans develop MA networks that meet CMS network adequacy criteria and resolve network challenges to avoid any compliance actions during this process.
These services include support with:
– Formal network review process
– CMS Consultation Process
– Preparation for Triennial Network Review

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Exception Requests

Exception Requests (ER) are a critical mechanism that plans can utilize in counties where it is not feasible to meet network criteria. We understand the ER process and can help plans develop appropriate ERs

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Consulting Services

Support organizations to identify new potential markets and service area expansions based on market environment and potential challenges meeting network adequacy criteria

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Tighter Medicare Advantage Network Adequacy Criteria Requirements for CY2024

CMS is returning to the original requirement that organizations demonstrate that they have an adequate network that meets criteria before CMS approves an application. CMS will allow for a temporary 10% credit (80% coverage -or 75% in certain county types) at the time of submission and plans will need to reach full compliance by the start of the contract year. This puts an additional burden on plans that will need to prepare their CY2024 networks and determine which new markets they want to expand into while they work on their CY2023 applications. Retium Health can help your organization by providing the necessary knowledge and capacity to support your team.