The filing needs a single access measure while the evidence records different parts of a member's journey.
The payer needs a defensible adequacy submission, while clinical review must not turn missing referral evidence into a claim about care.
Who you’d be doing this for
“My compliance team keeps asking who actually got seen, and I don't have one answer I can stand behind.”
Carlota Caruso · Behavioral Health Network Executive
Owns network adequacy evidence and member access performance for a health plan using the clinician network.
What is at stake
The payer cannot reconcile directory adequacy with members who never reach a timely appointment. You must weigh filing certainty against the risk of labeling an unobserved member journey as failed access.
Why it isn’t already fixed
Every obvious fix costs something else. That’s the part you’d have to decide.
- filing deadline vs evidence completeness
- payer defensibility vs clinical integrity
- member-level truth vs reporting continuity
- reusable measurement vs account-specific urgency
Why Headway
Referral integrations and network performance measurement place realized outpatient access at the center of payer relationships.
Written with these in mind
Not your kind of problem? 75 more at Headway, or browse every organization.
This is the setup. The work is inside.
Running it puts you in the room: the full situation and its constraints, stakeholders who push back in their own words, and the decisions that are yours to make. What you produce becomes a Day One Plan — work you can show someone instead of describing.