Network Adequacy Resource Hub
At J2 Health, we understand that tracking the latest regulatory standards, templates, and deadlines can be cumbersome. To make things easier for your and your teams, we’ve assembled key resources that we’ve found helpful when submitting network for approval. We’d love to be a resource to your and your team!
(Updated July 20, 2023)
This downloadable file contains national provider data organized on the clinician/enrollment record/group/address level.
(Updated July 21, 2021)
This downloadable file contains a national directory of substance abuse and mental health providers & facilities.
- Health Guide USA’s Hospital and Health Facility License Look Up
(Links updated March 19, 2023 )
This pages contains list of links to state hospital and facility licensed directories that enables plans to look up and verify licensing attributes.
- National Provider & Plan Enumeration System (NPES)
This National provider database is maintained by CMS and is searchable by NPL, Provider Name, and Organization Name.
(Updated August 8,2023)
Title 42 Chapter IV Subchapter B Part 422 Subpart C § 422.116
(Updated August 30, 2022)
A Guide to Medicare Advantage Adequacy Specialty Requirements & Geo-Access Standards by County Type. Includes HSD Specialty Crosswalk & Partial County Justification Template.
(Updated May 9, 2023)
The latest update to Medicare Advantage Standards which include a section more stringent requirements around Network Adequacy.
Need help? Submit any questions you have direct to the DMAO using this handy form.
Title 45 Subtitle A Subchapter B Part 156 Subpart C § 156.230
(Updated April 17, 2023)
Network Adequacy updates include new ECP thresholds and the inclusion of Substance Use Disorder Treatment Centers and mental health facilities as ECP specialties.
(Updated April 28, 2022)
Details on the QHP certification process that includes network adequacy time and distance tables.
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