Network Adequacy — eKlotho Nexus

Primary Care

94%

Threshold: 85% Adequate

Specialists

87%

Threshold: 85% Near Threshold

Hospitals

100%

Threshold: 90% Adequate

Mental Health

72%

Threshold: 85% Below Threshold

Network Adequacy Gaps Requiring Action

Mental Health — 72% (13% below 85% threshold)

12,400 affected members · Avg wait time 28 days vs 7-day standard · 3 counties with zero contracted providers

Critical

Endocrinology — 81% (4% below 85% threshold)

3,200 affected members · Avg drive time 38 mi vs 30-mi standard in 2 service areas

Moderate

Access Standards Compliance

Specialty	Max Dist Std	Max Wait Std	Avg Distance	Avg Wait	Status
Primary Care	15 mi	7 days	8.2 mi	4 days	Met
Cardiology	30 mi	14 days	18 mi	10 days	Met
Mental Health	30 mi	7 days	41 mi	28 days	Not Met
Endocrinology	30 mi	14 days	38 mi	18 days	Partial
Oncology	45 mi	14 days	22 mi	9 days	Met
Obstetrics	20 mi	7 days	12 mi	5 days	Met
Orthopedics	30 mi	14 days	19 mi	12 days	Met
Dermatology	30 mi	21 days	24 mi	24 days	Partial

Service Area Coverage Map

Interactive coverage map
with provider density overlay

PCP Specialist Gap Area

CMS Network Adequacy Requirements

PCP ≥85% adequacy within 15-mile standard
Hospital coverage ≥90% of service area population
Telehealth providers documented in directory
Specialist adequacy ≥85% (currently 87% — monitor)
Mental health ≥85% adequacy (72% — remediation required)
All specialties within wait-time standards
Provider directory accuracy ≥95% (97.2% verified)
Annual network adequacy report submitted

Page Guide — Network Adequacy

Overview

Network adequacy measures whether your contracted provider network can deliver timely access to care for all enrolled members. CMS requires annual attestation and remediation plans for any gaps.

Coverage summary cards show overall status by category
Red badges require immediate action
Submit corrective plans to CMS within 30 days of gap identification

Access Standards

CMS and state DOI set maximum drive distance and appointment wait-time standards by specialty type. "Partial" means standards are met in most but not all service areas within the region.

Gap Analysis

The gap box highlights specialties below threshold with member impact counts. Use "Recruit Providers" to initiate a credentialing pipeline, or "Telehealth Option" to document telehealth access as a substitute per CMS rules.

CMS Requirements

Annual report due: January 15
Remediation plan required within 30 days of gap
Provider directory must reflect real-time accuracy ≥95%
Telehealth may count toward adequacy with proper documentation