Provider Data Accuracy Resource Hub

Looking to improve your provider data accuracy and stay compliant with federal and state regulations? You’re in the right place! Dive into our growing resource library, packed with the latest news, actionable tips, and expert guidance to help you build a stronger, more reliable program.

Provider Data Accuracy: Trends From the Field

What if you could pinpoint where your provider network data stands and get the insights you need to succeed in your next directory audit? That’s what Vince Savickis, Solution Executive at Quest Analytics and his team, helped 10 health plans – who weren’t yet using Quest Analytics Accuracy Solution & Services – achieve.

Kate Deiters sits down with Vince to discuss the key findings, including the top three provider data errors, the evolving compliance requirements, and the practical steps to take to improve your data accuracy.

Learn About the QES Accuracy

Featured Resources

Provider Directory Accuracy Assessment Toolkit

Provider Directory Accuracy Assessment Toolkit Ensure Your Provider Directory Meets Regulatory Standards To meet diverse regulatory requirements, healthcare organizations must ensure provider directory accuracy. This involves developing and implementing documented,...

Open Enrollment: Connecting Consumers to Care Through Accurate Provider Data

Another open enrollment season is upon us. A time when millions of individuals, families, and employers evaluate their healthcare options, reflect on their care experiences, and decide how to move...

Network Adequacy and Provider Directory Accuracy Policy Updates

Federal and state regulators, along with lawmakers, are actively amending network adequacy and provider directory accuracy requirements while intensifying oversight. These changes have far-reaching implications for medical and ancillary plans....

Key Provider Outreach and Verification Metrics for Successful Provider Directory Audits

If you want to pass a provider directory audit, looking at your provider outreach analytics is a great place to start. With the right analytics, you can demonstrate compliance and...

How to Increase Practitioner Engagement for Data Verification

Provider data accuracy is the cornerstone of outstanding patient care, streamlined operations, and regulatory compliance. Despite its critical importance, the healthcare industry often encounters a formidable obstacle: obtaining timely responses...

Data Dilemma: How Inaccurate Information Undermines Payer Network Strategies

New Report: Becker’s Healthcare and Quest Analytics Data Dilemma: How Inaccurate Information Undermines Payer Network Strategies Even with record investments in network design, health plans continue to struggle with unreliable...

No Surprises Act Resources

The Guide for Accurate Provider Directories

The Guide To Provider Data Accuracy Download Now! Provider Data Management Tips And so it begins, the new era for provider directories. From roles & responsibilities to proven strategies to...

Provider Data Management Tips to Successfully Meet the No Surprises Act

We know the No Surprises Act can be a bit confusing, but no worries, we’re here to help. In this blog post, we’ll be sharing some insider insights and provider...

No Surprises Act: Protecting Patients and Improving Provider Directory Accuracy

When patients search for care, they rely on provider directories to guide them to the right clinician, without the risk of unexpected bills. Out-of-date directories can put patients at financial...

Ghost Networks Resources

Ghost Networks in Healthcare: What They Are and How To Address Them

Ghost networks have increasingly become a central topic in discussions within the healthcare sector and legislative circles. As this issue gains attention, it is crucial to understand the implications of...

The 5 Hidden Costs of Ghost Networks

Effective cost management is paramount for healthcare organizations, yet the issue of ghost providers remains a significant contributor to avoidable expenses. Through an analysis of the financial implications associated with...

The Requiring Enhanced & Accurate Lists of Health Providers Act

Accurate provider directories are essential to ensuring enrollees can access the care they need and deserve. Leading healthcare advocates echo this sentiment, which serves as the foundation for the proposed...

Listen to Our Latest Podcast Episodes

Episode: Provider Data Accuracy and Network Strategy: What Health Plan Executives Need to Know for 2026

Episode: Improving the Patient Care Journey with AI and Innovation

Episode: A Guide to AI-Driven Network Design

Explore More Podcast Episodes

How to Comply with California Provider Directory Requirements

California has been at the forefront of regulating provider directory accuracy, including addressing ghost networks. Every health plan in California must maintain updated directories of in-network healthcare providers for their...

5 Best Practices: Improving Provider Data Accuracy, Provider Outreach and Outcomes

Everyone’s buzzing about improving provider data accuracy and transparency these days—and for good reason. Just like an athlete training to reach peak performance, healthcare professionals like yourself need the right...

Provider Outreach and Verification

A Proven Approach to Provider Data Accuracy Download Now! Simplify Provider Data Verification with Attester-Driven Rolling 90-Day Outreach Are you a health plan professional striving to improve your provider verification...

How Network Adequacy Depends On Provider Data Accuracy

Let’s address the elephant in the room – the separation of network adequacy and provider data accuracy. We all know they’re both crucial for a successful provider network. Yet they’re...

Matching Providers to Potential Members: How Key Data Insights Drive Provider Network Design

Health insurers and managed care organizations strive to design networks that meet regulatory requirements and serve the unique needs of their communities. A well-designed provider network ensures access to high-quality...

CMS Provider Directory Pilot: What You Need to Know

CMS Qualified Health Plan (QHP) Directory Pilot The Centers for Medicare & Medicaid Services (CMS) launched a new provider directory pilot program with the Oklahoma Insurance Department (OID). Kate Deiters...

What Makes Quest Analytics Data Different

What Makes Quest Analytics Data Different Better Provider Network Decisions with Reliable Network Data Accurate healthcare network data is essential for effective network management, improving quality, lowering costs, and delivering...

Healthcare Payer Executives Reveal How Network Strategy and Design Drive Organizational Success

How are health insurance executives adapting their provider network strategies in a world where technology is rewriting the rules? For years, the healthcare industry has voiced concerns about unreliable and...

Building a Marketable Healthcare Provider Network

“Hands down, the most frequently asked question we get here at Quest Analytics is: ‘How can we be more strategic when it comes to network development?’” notes Eliza Hoffman, VP...

Find More Videos from Quest Analytics

Learn the latest news, insights, and strategies, from the experts at Quest Analytics. Explore our collection of provider network management videos on our YouTube channel.

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Join a Webinar On-Demand

Webinar: Stay Ahead of New Provider Directory Accuracy Requirements

Webinar: Stay Ahead Of New Provider Directory Requirements About This Webinar The No Surprises Act’s Provider Directory Verification requirements introduced critical changes to how healthcare organizations manage their provider directories....

Webinar Breaking Silos, Leveraging Efficiencies and Reducing Risk

Breaking Silos, Leveraging Efficiencies, and Reducing Risk Seeking scalability and visibility across all of Molina’s networks, one of their new SVPs started putting a plan in motion that has led...

Webinar: Facing the Realities of Provider Data Challenges to Improve Outcomes

Webinar: Facing the Realities of Provider Data Challenges to Improve Outcomes About This Webinar Healthcare provider data accuracy and integrity are foundational to provider networks, and with the evolving regulatory...

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Provider Data Management Tips to Successfully Meet the No Surprises Act

Health plans must have a documented, defendable process in place to show the effort they’re making to comply with the provider directory verification requirements. What should this process look like? We have the answer!

FAQs and Provider Directory Requirements: Key Tips and Targets

We answer the most frequently asked question that health plans are asking us regarding the CAA Provider Directory Requirements. We also share tips and targets to help you get ahead in the coming months.

The Hottest Trends across health insurance markets

The data is in—and it’s clear: provider network oversight, provider data accuracy and provider data transparency are the hot trends across all health insurance markets. Find out what this means for you.

On-Demand Webinar: AHIP & Quest Analytics Present

STAY AHEAD OF NEW PROVIDER DIRECTORY REQUIREMENTS

Quest Analytics partnered with AHIP to continue the conversation about the new Provider Directory Verification requirements listed in the No Surprises Act. Watch now and learn about:

The new provider directory accuracy requirements for health plans and providers
The impact the requirements have on your business
Which strategies to implement now

Access On-Demand Webinar

On-Demand Webinar

No Surprises Act: What You Need to Know and Why

The No Surprises Act includes regulations that will affect most of our health plan clients. As many are just learning about the new provider data requirements, we want to share the cliff notes and answer the most common questions. Watch the on-demand webinar to learn best practices, strategies, and actionable steps you can take today to align with the new federal requirements.

The New Provider Directory Accuracy Mandate

Under the No Surprises Act, commercial, qualified health plans (QHPs), and employer-based health plans are required to maintain accurate provider directories. Read our legislative brief to learn about the new requirements that health plans and providers need to meet.

White Paper

Surprises in the No Surprises Act for Health Plans and Providers

The new provider directory verification requirements continue to surprise most health plans and providers. Discover what each party needs to do to update the provider directory, and how to design your process to comply with the accuracy requirements.

Best Practices

Implementation In Four Phases

There is a lot to consider and accomplish as you prepare for the mandate. Where do you begin? What happens next? What is a realistic timeline? We’ve mapped out the process for you. Download the Four Phases of Implementing a Provider Data Verification process.

Best Practices

Eleven Questions to Ask Your Teams

As a best practice when preparing for the Provider Data and Directory Verification mandate, it is imperative that you understand your current process. Download the top eleven questions we recommend you ask your teams.

Best Practices

Frequently Asked Questions

Section 116: Protecting Patients and Improving the Accuracy of the Provider Directory Information, requires health plans and providers to work together to maintain up-to-date provider directories. Discover the answers to the top questions about the new requirements.

LEARN MORE WITH RELATED RESOURCES

Insights Article

TRANSPARENCY IN COVERAGE

Insights Article

TRANSPARENCY IN COVERAGE

Success Stories

Accelerating Territory Expansion in Three Months with Quest Enterprise Services®

Learn how this health plan accelerated its expansion into new counties and states.

Removing Compliance Guesswork: A Healthcare Network Adequacy Case Study

They had no effective way to find their own adequacy gaps — but CMS and state regulators were finding plenty

Achieving Enterprise-Wide Compliance Across Medicare and Medicaid Networks

Struggling to meet the diverse adequacy requirements of CMS and states, the plan needed a smarter way to work.

How Quest Analytics Helped a Health System Build Their Own CMS-Compliant HMO

Wanting to set up their own HMO, they needed to build a county-wide Medicare Advantage network — with no previous experience managing CMS network adequacy requirements

How QES® Transformed Medicare and Medicaid Network Building

Having struggled to build a Medicaid network, they now faced the more complex requirements of Medicare — with only one shot to get it right.

The ROI Of Provider Network Management

On-Demand Webinar The ROI of Provider Network Management Quest Enterprise Services® provides a positive ROI for Provider Network Management Hear how a New York health plan uses Quest Enterprise Services...

Explore Success Stories

Schedule Your Complimentary Strategy Session

Compliance isn’t our name, but it sure is our game! Learn how we can assist your efforts to make your provider data accurate and network adequate. Book a complimentary strategy session with a Quest Analytics expert to get started on your quest for success.

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