Medical Provider Network Regulations

DWC Medical Provider Network

https://www.dir.ca.gov/dwc/mpn/DWC_MPN_Main.html

A medical provider network (MPN) is an entity or group of health care providers set up by an insurer or self-insured employer and approved by DWC's administrative director to treat workers injured on the job. Under state regulations, each MPN must include a mix of …

Regulation of Health Plan Provider Networks | Health Affairs

https://www.healthaffairs.org/do/10.1377/hpb20160728.898461/

Network Adequacy: Rules Insurance Carriers Must …

https://www.verywellhealth.com/network-adequacy-rules-5442961

As of 2023, the federal government, through the Centers for Medicare and Medicaid Services (CMS), is resuming responsibility for ensuring that health plans sold in …

45 CFR § 156.230 - Network adequacy standards.

https://www.law.cornell.edu/cfr/text/45/156.230

(2) For plan years beginning on or after January 1, 2016, a QHP issuer must publish an up-to-date, accurate, and complete provider directory, including …

Network Adequacy Standards and Enforcement | KFF

https://www.kff.org/health-reform/issue-brief/network-adequacy-standards-and-enforcement/

A Unique State Approach to Network Regulation and Transparency – The New Hampshire Insurance Department (NHID) developed a novel approach to assessing …

Provider requirements and resources | CMS

https://www.cms.gov/nosurprises/Policies-and-Resources/Provider-requirements-and-resources

Information for providers and facilities on these No Surprises rules: 1) balance billing disclosure requirements; 2) protections for certain continuing care patients whose plan …

Provider Requirements | CMS

https://www.cms.gov/Medicare-Medicaid-Coordination/Fraud-Prevention/Medicaid-Integrity-Program/Education/Provider-Requirements

Provider Requirements Provider Requirements We have created the resources below to help states with a range of topics in provider management …

Out-of-network law: What physicians need to know - CMS

https://www.cms.org/articles/out-of-network-law-what-physicians-need-to-know

Carrier disclosures: When a covered person has incurred a claim for emergency or non-emergency health care services from an out-of-network provider, …

Medical Providers | U.S. Department of Labor - DOL

https://www.dol.gov/agencies/owcp/medical_providers

Information for Treatment Providers; Information for Diagnostic Providers; Online Training; Medical Bill Processing Procedures; Medical Bill Processing Portal; Fee Schedules; …