Network adequacy
Network adequacy is whether a health plan's network has enough providers of each type, close enough to members, to give reasonable access to care. Medicare Advantage standards set provider counts and time and distance limits by specialty and county type.
How is network adequacy measured?
For Medicare Advantage, 42 CFR 422.116 sets minimum numbers of providers and maximum travel times and distances, by specialty and by county type, from large metro to rural. Plans show they meet them using their provider data.
Why does provider data accuracy matter for adequacy?
Adequacy is calculated from the provider list. If the list includes providers who have left, moved or don't take new patients, the network passes on paper but members can't get care. That gap is what people call a ghost network.
Accuracy and adequacy together
Removing wrong listings can make a network look smaller. Plans need to know which listings are real so they can fix gaps by recruiting, rather than by keeping stale entries.