Medicare Advantage Network Adequacy & Development
MyQualityCareNetwork helps Medicare Advantage organizations evaluate network adequacy against current CMS contract-year standards, identify specialty and county access gaps, prioritize provider contracting, and prepare Health Service Delivery (HSD) tables for submission.
Medicare Advantage Network Adequacy Solutions
From a single-county expansion to a multi-state service area, we support every stage of Medicare Advantage network development: adequacy analysis, gap identification, contracting strategy, HSD preparation, and ongoing monitoring as your network changes.
Network adequacy analysis
Estimated access percentages by county and specialty, measured against the time, distance, and minimum number standards CMS publishes for your contract year.
CMS network adequacy mapping
ZIP-level coverage maps that show exactly where members fall outside estimated drive-time and distance ranges for each required specialty.
Provider contracting strategy
Ranked lists of non-par providers in the market whose addition is estimated to close the most access gaps, so your team targets the right candidates first.
CMS Time-and-Distance Network Analysis
CMS network adequacy standards vary by county type — from large metro to rural — and by specialty. We measure estimated drive time and distance from member locations to your contracted providers and compare the results against the standards in effect for your contract year, county by county and specialty by specialty.
- County-type-specific time and distance standards, never a single threshold applied everywhere
- Both drive time and mileage evaluated, because CMS requires each
- Member locations weighted by ZIP-level population and county enrollment
- Results labeled as planning estimates — distinct from formal CMS adequacy determinations
Specialty and County Gap Identification
An MA network gap analysis is only useful if it tells you exactly what is missing and where. Our reports list every specialty that falls below its access standard in every county you serve, the current estimated access percentage, the percentage required, and whether the shortfall is drive time, distance, provider count, or a combination.
That level of detail turns a pass/fail question into a contracting work plan your team can execute.
Provider Recruitment and Contracting
Ranked non-par candidates
Providers in the market who are not in your network, ranked by the estimated member impact of adding them — by specialty, county, and ZIP code.
Before-and-after modeling
See the estimated access percentage change before you contract: add a candidate to a scenario and watch the projected coverage change on the map.
Your team or ours
Hand the ranked target list to your internal contracting team, or engage our network development team to pursue candidates on your behalf.
HSD Preparation and Data Validation
CMS Health Service Delivery tables are the format plans use to report their provider and facility networks. We prepare Provider and Facility HSD tables filled from your contracted network, in the column order the current guidance expects, with a review sheet that flags missing or inconsistent data before you transfer the tables into the official templates.
- Provider HSD and Facility HSD tables generated from your contracted roster
- Data validation flags — missing NPIs, incomplete addresses, unmapped specialties
- Built from the CMS standards file for your contract year
Market and County Expansion Feasibility
County-by-county feasibility
Before you file a service area expansion, see which target counties your existing network already covers and which need new contracting.
Market supply visibility
We maintain provider supply data across all 50 states and DC, so candidate identification works in any market you are evaluating.
Facility coverage
Hospitals, skilled nursing, and other facility categories evaluated against minimum number standards alongside your provider network.
Illustrative Network Access Case Study
In an illustrative Orange County, Florida analysis for Allergy and Immunology, the existing network showed an estimated 62.1% of members within access range — below the 90% reference line for that county type. Adding a single targeted non-par provider raised the estimated figure to 98.0%, with four ZIP code gaps remaining. This example is illustrative; it is not a confirmed CMS compliance result.
See the full walkthrough on the Health Plans pageNetwork Development Methodology
Assess
Measure your current network against the CMS standards for your contract year, county type, and specialty.
Prioritize
Rank gaps by estimated member impact so contracting effort goes where it matters most.
Develop
Target and contract the non-par providers estimated to close the most access gaps.
Validate
Re-measure after each addition and prepare HSD tables and documentation for submission.
Built by Healthcare Network Leadership. Designed for Health Plan Challenges.
MyQualityCareNetwork 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
- More than 30 years of managed care experience
- Provider network development leadership
- Medicare Advantage network experience
- Medicaid managed care contracting
- Network expansion initiatives
- CMS HSD and adequacy experience
- Provider network operations
- Executive leadership
Request an MA Network Assessment
Tell us the counties and specialties you are evaluating, and we will show you where your network stands — and what it would take to close the gaps.
Keep exploring
- For Health Plans — the full range of network solutions for MA and Medicaid plans.
- Insights — articles on network adequacy, contracting, and expansion.
- Contact — start a conversation about your network.
Build the network before the gap shows up on a CMS report.
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.