Network Requirements for Exchange Plan Providers

Under the Affordable Care Act, the provider networks for Exchange plans must meet specific requirements in order to be compliant.

The provider networks must meet the following criteria:

  1. Have adequate coverage including coverage in areas that will serve low income communities.
  2. Provide general contracting specifications designed to create a level playing field for rural and small communities.
  3. Ensure quality standards for improvement within the networks.
  4. Comply with all HIPAA and privacy standards under the statute.

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