Welcome To Retium Health
Your Partner for Provider Network Adequacy
Helping Medicare Advantage Organizations meet CMS network criteria
CMS Medicare Advantage and Prescription Drug Benefit new proposed rule for CY2023
Who we are
Focusing on services to develop and improve Medicare Advantage (MA) provider networks, Retium Health will help ensure that MA networks comply with CMS’s network adequacy criteria.
We provide in-depth knowledge and expertise to service your needs. Members of our team led the work that supported CMS with the development of the current network adequacy standards bringing more than 10 years of direct experience with network criteria and the CMS review process. Thanks to our thorough understanding of network adequacy criteria and the review process, we can help MA organizations improve the quality of their network submissions and provide comprehensive solutions to address CMS network concerns.
Retium Health supports health plans to develop Medicare Advantage networks that are compliant with CMS’s network adequacy criteria.
Our services
Our goal is to support Medicare Advantage Organizations through the entire CMS provider network review process.
Real Expertise in Medicare Advantage Network Adequacy Standards
Members of the Retium Health team worked with CMS to develop the Medicare Advantage Provider Network Adequacy Criteria and the Exception Request process
Provider network adequacy, a critical component of your plan’s success
Federal Regulation 42 CFR § 422.112 (a)(1)(i) establishes that an MA organization that offers a MA coordinated care plan must “maintain and monitor a network of appropriate providers that is supported by written agreements and is sufficient to provide adequate access to covered services to meet the needs of the population served”.
The risks of not managing your networks appropriately are significant. Failure to meet CMS network requirements may lead to compliance actions by CMS, including suppression from the Medicare Plan Finder, with important economic consequences that can detract from your success in one of the most attractive markets for health plans.
