Identify Network Gaps. Strengthen Provider Access. Expand With Confidence.
MyQualityCareNetwork helps Medicare Advantage and Medicaid managed care organizations evaluate network adequacy, identify provider access gaps, prioritize contracting opportunities, and develop networks that support market expansion and regulatory readiness.
Health plans of every size, national or small and local, can engage us for network adequacy results.
Support Medicare Advantage network development through CMS network adequacy analysis, geographic access evaluations, provider contracting strategy, HSD preparation, and market expansion planning.
Support Medicaid managed care organizations through state-specific network adequacy analysis, provider contracting, network development, behavioral health access planning, LTSS networks, and Medicaid market expansion.
Medicare Advantage and Medicaid network adequacy rules are set separately: CMS for Medicare Advantage, and each state's Medicaid contract for Medicaid managed care.
From identifying provider access deficiencies to developing stronger networks, MyQualityCareNetwork helps health plans turn network intelligence into practical action.
Evaluate provider supply and geographic access before entering new counties or markets.
Identify potential providers and locations that may offer the greatest improvement in geographic access.
Support targeted provider outreach, contract negotiations, and network development strategy.
Support network data validation, applicable adequacy reporting, and regulatory submission preparation.
Measure member access to your contracted network against the standards that apply to your market.
Medicare Advantage results use CMS contract-year standards. Medicaid assessments follow each state's managed care contract requirements.
Before you file for a new service area, understand the provider supply and access picture county by county.
Turn gap findings into a prioritized list of where added providers would improve access the most.
Support your team's outreach, or engage ours, to bring identified providers into your network.
Submission-ready network data tables prepared from your contracted roster.
HSD table formats apply to Medicare Advantage submissions. Medicaid reporting formats vary by state and are prepared to that state's specification.
Keep adequacy results current as your roster, the market, and the standards change.
Orange County, Florida · Allergy and Immunology (007). Switch between the current network and a proposed single-provider addition to see how estimated member access changes.
Estimated member access
Illustrative reference threshold: 90%. Estimated change: +35.9 percentage points.
An estimated 62.1% of members fall within the access standard, below the 90% reference threshold. Multiple ZIP codes sit outside time and distance limits for this specialty.
Analyze network supply, geographic access, and potential deficiencies.
Identify opportunities by specialty, county, provider location, and potential impact.
Support provider recruitment, contracting, and strategic network expansion.
Reassess access, review provider data, and support applicable regulatory readiness.
Engagements produce county-level executive reports, specialty gap analyses, nonparticipating provider opportunity lists, provider data validation examples, and HSD preparation samples. Medicare Advantage deliverables follow CMS HSD formats; Medicaid deliverables are tailored to each state's submission requirements.
County and ZIP level views of where your contracted network reaches members and where it falls short.
Every specialty below its access standard, with the current estimated percentage and the requirement it is measured against.
Providers in the market who are not in your network, ranked by the gaps they could help close.
Provider and facility HSD tables filled from the contracted network, in the column order CMS templates expect.
Facility-level detail by county, ready to transfer into the templates used for submission.
Tell us the state, counties, and specialties you are evaluating and we will follow up with a sample tailored to your network.
Request a Sample ReportMyQualityCareNetwork combines data-driven geographic network analysis with decades of hands-on managed care executive experience.
Our approach draws on expertise in Medicare Advantage, Medicaid managed care, provider network contracting, geographic expansion, regulatory reporting, and network operations.
Identifying a network deficiency is only the beginning. Our focus is on developing practical strategies that help health plans prioritize contracting opportunities, strengthen provider relationships, and improve network readiness.
Learn more about us
Felix Gonzalez
Founder, MyQualityCareNetwork
Approved provider counts by provider specialty, state, county and ZIP codes across your coverage areas.
Primary care, OB/GYN, dermatology, ENT, and all required specialties under CMS or State Medicaid standards.
Understand if your expansion network is ready for submission. Know if you are meeting network access requirements before you submit.
National, regional, and small local plans can engage us for network adequacy results.
Network adequacy in focus
Evaluate member access by specialty and ZIP code, identify non-par providers with potential to close gaps, compare your current network with a proposed contracting scenario, and receive a full report of the specialty gaps that remain before you submit for expansion.
Current estimated member access
62.1%
With one proposed non-par provider
98%
Example specialty access threshold
90%
Illustrated case: Orange County, Florida · Allergy and Immunology (007). Percentages describe estimated members with access, not the percentage of providers or specialties meeting requirements.
01
County and ZIP views highlight where estimated access falls below the selected specialty’s standards. In this example, about 53,191 of 140,207 estimated members are outside the 15-mile distance rule for Allergy and Immunology.
02
CMS supply data identifies providers outside your existing network. Candidates are ranked by the estimated members they could bring within range, helping focus contracting discussions on locations with the greatest potential impact.
03
Model a non-par provider’s location before pursuing a contract. Here, one proposed addition raises estimated member access from 62.1% to 98%, above the example’s 90% threshold. The map also identifies the gaps still left to close.
04
Every analysis ends in a complete report listing each specialty that still falls short, the share of estimated members with access today, and the access standard that specialty must reach. Alongside the gaps, we show providers in the market that are not in your network so your team or ours can target them for contracting and close gaps before you submit for expansion.
Market providers are drawn from CMS supply data. Inclusion does not establish contracting interest, availability, or that a gap will close.
Screenshots show an illustrative analysis, not a guarantee of results. Baseline access uses drive time and distance; scenario additions use straight-line distance and estimated ZIP-level member geography. Contracting, provider eligibility, availability, and a full time-and-distance reanalysis must be confirmed.
Submission-ready reporting
We deliver Health Service Delivery (HSD) tables built in the CMS Appendix H and Appendix J column layout, filled from your contracted network and ready to include in submissions to CMS or a State Medicaid RFP. Each engagement is tailored to the requirements set by CMS for the contract year, or by your State Medicaid contract.
Plans submit HSD data using the templates downloaded from CMS's HPMS system; our tables are prepared in that same layout so your team can transfer them directly. Only contracted providers are listed. Prepared tables support your submission and do not by themselves constitute CMS or State Medicaid approval.
Health plan users see network coverage at the county and specialty level. Private provider documents, credentialing data, and personal contact details are never exposed without explicit provider approval.
National, regional, and small local plans can commission network adequacy work for the markets they serve or are considering. Results are operational estimates built from the contract year, county, and specialty standards you select.
Access measured by drive time and distance against county and specialty standards for a contract year.
County and ZIP level coverage, with non-par providers that would close the largest remaining gaps.
County, specialty, and ZIP detail in spreadsheet and PDF form for internal review.
Tell us where you're looking — state, counties, specialties — and we'll share the relevant aggregate coverage profile and follow up to schedule a network development conversation.
Subject to provider approval, credentialing, contracting, and applicable agreement terms. Aggregate views are operational planning tools and do not represent a formal CMS network adequacy determination.
Our assessments are planning estimates that support your submission work. They do not guarantee regulatory approval or compliance.
Whether you're a behavioral health provider exploring network participation opportunities or a health plan starting plan access discussions, we'd like to hear from you.