YOUR MEDICARE ADVANTAGE NETWORK SUBMISSION

6 ESSENTIAL STEPS TO COMPLIANT HSD TABLES

Ensuring your network submission is compliant with the Centers for Medicare & Medicaid Services (CMS) requirements is vital for maximizing plan success. Whether you’re fine-tuning your data for a network submission or looking to avoid compliance issues throughout the year, here are six essential steps to guide you through the process.

STEP 1: STAY INFORMED ON REQUIREMENTS

Network adequacy and provider directory accuracy requirements can change annually. Staying informed about the latest standards and requirements helps you stay compliant and prepared. Pay attention to new provider or facility specialties that must be listed in your Health Service Delivery (HSD) tables. Additionally, keep an eye on changes in County Classification and Beneficiary Files.

TIP: Bookmark our Medicare Advantage Resource Hub to find the latest news.

STEP 2: PERFORM REGULAR DATA VALIDATION

Accurate provider data is foundational for network submissions. Ensure that providers in your HSD Tables meet the following criteria:

• Recently Attested Information: Providers must have recently verified their information.

• Valid and Active NPI: Confirm that each provider’s National Provider Identifier (NPI) is valid and active according to the National Plan and Provider Enumeration System (NPPES).

• Medicare Eligibility: Providers should not have opted out of Medicare.

• No Sanctions: Ensure providers are not sanctioned by federal programs or relevant state licensing boards.

TIP: Use our Medicare Advantage Toolkit for more on mandated provider data elements to verify.

STEP 3: IDENTIFY PROVIDERS WITH EXCESSIVE LOCATIONS

To align with CMS guidelines, limit each provider to a maximum of 10 locations. Include only the locations where members can regularly schedule appointments. Exclude locations where the provider is a substitute or temporarily stationed.

TIP: Use Quest Enterprise Services^® Accuracy to identify the locations where the provider is actively seeing members.

STEP 4: MATCH HSD TABLES & PROVIDER DIRECTORIES

Verify that the provider NPI and address combination in your HSD Tables match your provider directories. Remove any mismatched combinations to ensure alignment.

STEP 5: REASSESS YOUR PROVIDER NETWORK

Re-evaluating your provider network is essential whenever you update your data or remove providers who no longer meet your criteria. Changes in your data can significantly impact your network access. By evaluating your network, you can identify any gaps in compliance.

Keep in mind CMS mandates quick correction of non-compliant networks. Therefore, it’s important to promptly address and fill any gaps as soon as they are identified.

TIP: Use Quest Enterprise Services^® to quickly identify the right provider to fill the gap and stay compliant.

STEP 6: SUBMIT YOUR NETWORK DATA

Once you’re ready, submit your network data to CMS. You’ll need to complete and send two HSD tables for each contract: one for providers and one for facilities.

TIP: Read our blog post to learn the latest application rules.

By following these steps, you’ll be better equipped to ensure your HSD tables are compliant, reducing the risk of delays or rejections in your Medicare Advantage network submissions.

GET A JUMP ON YOUR NETWORK ® SUBMISSION WITH QUEST ANALYTICS

Discover more about how Quest Enterprise Services® can assist you in maintaining a compliant network. Schedule your consultation now!