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Posted on: January 3, 2020

Network Adequacy Standards - Annual Certifications Due February 1st

Click here to learn about the memorandum for all insurers licensed to transact accident and health i

Network Adequacy Standards – Annual Certifications Due February 1st

In accordance with Bulletin 2013-04, Appendix C, Item 9 under the section titled Provider Network Adequacy Guidelines, each Issuer must file an access plan with the filing for initial approval of the network plan showing the provider network, and by February 1st of each year thereafter, that shows how it was determined that provider network meets the network adequacy requirements set forth in this Network Adequacy Standard. The guidelines outlined in Appendix C of Bulletin 2013-04 and the "Managed Care Plan Network Adequacy Model Act" should also be used for reference. The access plan should include a description of the network, referral procedures, ongoing monitoring, and any reasonable criteria used by the Issuer to determine network adequacy. The access plan should be labeled as "CONFIDENTIAL" and submitted as a separate user-added supporting document in the SERFF filing that is marked as not for public access. Radius maps must be included in the access plan. Use of "GeoAccess" or something similar is encouraged. The initial access plan should be accompanied by a certification by an officer of the Issuer that the requirements set forth in this Network Adequacy Standard have been met. After the first submission, the Issuer may certify annually that there have been no substantive changes in the network, and attach a current provider directory (in lieu of a complete description analysis). This letter must come from an officer of the company and specify the addition or loss of any hospital providers.

Click here to view the official memorandum to all insurers licensed to transact accident and health insurance business within the state of South Carolina and all South Carolina licensed health maintenance organizations.

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