What is Network Management Module (NMM)

Network Management Module (NMM) Definition

The NMM is the "Gatekeeper" of the CMS review process. For Payer Ops, it is the interface where "Strategy meets Regulation." Once HSD tables are uploaded to the NMM, CMS runs automated geospatial algorithms to determine if the network meets the required standards for the specific county type (Large Metro, Metro, Micro, Rural, or CEAC). For C-level Executives, the NMM provides the final "Scorecard" for the plan’s network development efforts. A key operational risk is "Data Latency"—if the data in the NMM is not the most current reflection of the signed contracts and credentialed providers, the plan may fail unnecessarily. Successfully navigating the NMM requires a "Pre-Submission Audit" process to ensure that the NPIs, addresses, and specialties being uploaded are 100% verified against primary sources.

FAQs

t is primarily used for Medicare Advantage (MA), Section 1876 Cost Plans, and certain Medicaid/Medicare dual-eligible plans.

It is primarily used for Medicare Advantage (MA), Section 1876 Cost Plans, and certain Medicaid/Medicare dual-eligible plans.

What is the "Automated Criteria Check" in the NMM?

It is the software logic that instantly compares a plan’s HSD submission against CMS’s minimum provider counts and time/distance benchmarks for every county.

Can a plan see their NMM results in real-time?

After the submission window closes, CMS provides reports through the NMM that highlight specific zip codes or specialties where the plan failed to meet standards.