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Episode 263: Empowering Plans: P224 – CMS Spotlight: Cleaning Up Provider Data and Fixing IDR Errors

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Manage episode 497580410 series 3337794
Content provided by The Phia Group. All podcast content including episodes, graphics, and podcast descriptions are uploaded and provided directly by The Phia Group or their podcast platform partner. If you believe someone is using your copyrighted work without your permission, you can follow the process outlined here https://podcastplayer.com/legal.

In this episode, we take a closer look at two key developments out of CMS that could reshape how provider data and dispute resolution work in practice. First, we explore the agency’s proposed National Provider Directory — an ambitious effort to clean up fragmented provider data and reduce ghost networks. Then, we break down insights from the July 2025 CMS Technical Assistance Seminar, which tackled the growing problem of errors in the Federal Independent Dispute Resolution (IDR) process — from procedural missteps to jurisdictional mistakes and default determinations on ineligible claims. What’s CMS doing to fix the system — and what gaps are still leaving plans vulnerable?

  continue reading

100 episodes

Artwork
iconShare
 
Manage episode 497580410 series 3337794
Content provided by The Phia Group. All podcast content including episodes, graphics, and podcast descriptions are uploaded and provided directly by The Phia Group or their podcast platform partner. If you believe someone is using your copyrighted work without your permission, you can follow the process outlined here https://podcastplayer.com/legal.

In this episode, we take a closer look at two key developments out of CMS that could reshape how provider data and dispute resolution work in practice. First, we explore the agency’s proposed National Provider Directory — an ambitious effort to clean up fragmented provider data and reduce ghost networks. Then, we break down insights from the July 2025 CMS Technical Assistance Seminar, which tackled the growing problem of errors in the Federal Independent Dispute Resolution (IDR) process — from procedural missteps to jurisdictional mistakes and default determinations on ineligible claims. What’s CMS doing to fix the system — and what gaps are still leaving plans vulnerable?

  continue reading

100 episodes

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