UC-425
Network Adequacy and Recruitment Ranking
Tests the provider network against time and distance standards by county and speciality, and ranks which contracts to chase first.
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The Challenge
Filings fail on a handful of counties and specialities nobody saw until the regulator ran the test. Provider rosters, directory records and contract status disagree about who is even accepting new patients.
How It Works
- Reads provider rosters, contract status, directory records, claims activity and standards.
- Tests each county and speciality against time and distance rules and scores each signing.
- Gives network management a ranked recruitment list and a filing-ready adequacy exhibit.
What It Removes
- Manual county-by-county adequacy spreadsheets
- Directory clean-up sweeps ahead of every filing
- Guesswork about which speciality gap to close first
Input Data RequirementsProvider rosters and contracts, directory records, claims-derived practice activity, membership geography, regulator distance standards, service areas
Output FormatAdequacy pass and fail map by county and speciality, ranked provider recruitment list, filing-ready exhibit per product and market
“We learn we are two cardiologists short in one county when the filing comes back, not when we could fix it”