On March 31st of each year, all full service and mental health plans are required to file a comprehensive Timely Access Report (TAR) and an Annual Provider Network (APN) filing, including Network Adequacy Grievance Reports, and Out-of-Network Payment Reports with the Department of Managed Health Care (DMHC). The DMHC issues detailed instructions for the filings and typically makes modifications to the filing requirements and template format and field instructions each year. The DMHC has issued Enforcement Actions for incomplete, inaccurate or improperly filed regulatory submissions related to timely access to care requirements. QMetrics can assist plans with these filings by performing a third-party unbiassed quality review of the plan’s TAR and/or APN submissions for accuracy and completeness prior to DMHC submission. Some services offered in this area include the following:
- Comprehensive document and data review of A – F Timely Access Report (TAR) Compliance Report Requirements
- Qualitative and quantitative review of all documents and data prior to submission
- Review of Annual Provider Network (APN) Report Forms for completeness, formatting, and adherence to DMHC requirements (Annual Provider Network Submission Instruction Manual requirements and Annual Provider Network Report Form template specifications and instructions) prior to DMHC submission
- Assessment of provider network for compliance with regulatory network adequacy requirements
Contact us at: firstname.lastname@example.org for a complimentary consultation.