Three-Year Network Adequacy Review for Medicare Advantage Organizations

Documents and forms in this information collection

Document Name	Document Type
Form CMS-10636 Provider HSD Table Three-Year Network Adequacy Review for Medicare Advantage Organizations	Form
Form CMS-10636 Facility HSD Table Three-Year Network Adequacy Review for Medicare Advantage Organizations	Form
Form CMS-10636 Exception Request Template Three-Year Network Adequacy Review for Medicare Advantage Organizations	Form
Form CMS-10636 Partial County Justification Template Three-Year Network Adequacy Review for Medicare Advantage Organizations	Form and Instruction
Form CMS-10636 HPMS Web Based Application: NMM Three-Year Network Adequacy Review for Medicare Advantage Organizations	Form
MA_Network_Adequacy_Guidance_4205-F_CLEAN.pdf	Instruction
MA_Network_Adequacy_Guidance_4205-F_CLEAN.pdf	Instruction
CMS-10636 Provider HSD Table MA_Provider_Table_Template NEW 508.pdf	Form
CMS-10636 Provider HSD Table MA_Provider_Table_Template NEW 508.pdf	Form
CMS-10636 Facility HSD Table MA_Facility_Table_Template NEW 508.pdf	Form
CMS-10636 Facility HSD Table MA_Facility_Table_Template NEW 508.pdf	Form
CMS-10636 Exception Request Template MA_Exception_Template_REVISED.pdf	Form
CMS-10636 Exception Request Template MA_Exception_Template_REVISED.pdf	Form
CMS-10636 Partial County Justification Template Partial_County_Justification_Template_(2022 version) NO CHANGES 508.pdf	Form and Instruction
CMS-10636 Partial County Justification Template Partial_County_Justification_Template_(2022 version) NO CHANGES 508.pdf	Form and Instruction
CMS-10636 HPMS Web Based Application: NMM Telehealth NMM Page Proposed Changes.pdf	Form
CMS-10636 HPMS Web Based Application: NMM Telehealth NMM Page Proposed Changes.pdf	Form
MA_Network_Adequacy_Guidance_4205-F_Track changes_03062024.pdf Redline: Network Adequacy Guidance	IC Document
MA_Network_Adequacy_Guidance_4205-F_Track changes_03062024.pdf Redline: Network Adequacy Guidance	IC Document
Provider HSD Table Crosswalk 508.pdf Crosswalk: Provider HSD Table	IC Document
Provider HSD Table Crosswalk 508.pdf Crosswalk: Provider HSD Table	IC Document
Facility HSD Table Crosswalk 508.pdf Crosswalk: Facility HSD Table Template	IC Document
Facility HSD Table Crosswalk 508.pdf Crosswalk: Facility HSD Table Template	IC Document
Exception Request Template Crosswalk.pdf Crosswalk: Exception Request Template	IC Document
Exception Request Template Crosswalk.pdf Crosswalk: Exception Request Template	IC Document
HPMS NMM Crosswalk.pdf Crosswalk: Network Management Module (NMM)	IC Document
HPMS NMM Crosswalk.pdf Crosswalk: Network Management Module (NMM)	IC Document

            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.