WE TAKE HEALTHCARE NETWORKS FROM ADEQUATE TO EXCELLENT

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POWERING PROVIDER NETWORK MANAGEMENT

Quest Analytics® makes it easier for payers, health plans, health systems & provider groups and third-party administrators (TPAs) to design, optimize and manage their provider networks. With our tools, data and guidance, you can tackle today’s toughest challenges in less time—across all business lines. Our solution isn’t a one-size-fits-all, no siree. We work with you to determine the right solutions for your needs. And, we’ve been doing this across the healthcare industry for years. Federal and State regulators partner with us to automate their network review processes, strengthen their consumer protection programs and make better-informed policy recommendations. What if you’re a consultant or benefits broker? You’re in luck, you too can benefit from partnering with us. How? With our solutions, you can streamline your network evaluations by comparing multiple networks side-by-side in one view and rest assured that you are recommending the ones that are the best fit for your clients. Whether you’re looking to maintain regulatory compliance with confidence or wanting to take your networks to the next level, we can help.

WE KNOW YOUR CHALLENGES

Let’s face it, today’s complex regulatory landscape combined with a growing list of new reporting measures like health equity, provider quality, telehealth, surprise billing and social determinants of health can make gaining a competitive advantage seem insurmountable. That’s why Quest Analytics continually evolves with the industry to create the only enterprise solution that brings together real-time provider network adequacy and directory accuracy. Our solutions streamline your organization’s efficiency while simplifying your day-to-day tasks related to provider data management, CMS compliance, market expansion, and provider recruitment.

We know your challenges and have tailored our solutions to help you achieve success.

Network Adequacy Tool Process: Adequacy, Impact, Opportunity and Termination Analysis. Data Trending Over Time. Gap Age Tracking. Market Analysis. Provider Claims Insights (PCI).

NETWORK ADEQUACY

Having an Adequate network is one thing but having an Excellent network requires thinking beyond time and distance standards to understand member access. Regulations and the provider landscape are dynamic and require knowledge of your provider networks (including breadth); the markets you serve; how members acquire care and how your organization will grow in the future.

If you’re looking to gain the extra edge in your market, our Quest Enterprise ServicesTM (QESTM) network management platform goes beyond traditional network adequacy analysis by giving you real-time actionable insights into:

  • How a particular provider could fill or close gaps in your networks.
  • How removing a provider impacts your network.
  • The level of effort and reward for service area expansion opportunities.
  • How including SDoH and telehealth affect your networks.
  • The depth, breadth and quality of your networks.
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PROVIDER DATA ACCURACY

A critical piece that takes your provider network from adequate to excellent is understanding and managing provider data accuracy and its impact on your network adequacy.

Addressing the accuracy of your data is now mandated for all lines of business by both federal and state regulators to stop surprise billing, ensure consumer protections and, ultimately, improve your member’s experience.

With Quest Enterprise Services, we combine actionable insights into those critical auditable areas with verified data sources, including outreach and attestations through our BetterDoctorTM services, to identify quickly, address and prioritize high-risk challenges, including inspectors for data completeness, integrity, validity and more.

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MEMBER ACCESS

Member access to care is the foundation for maintaining an adequate network and creating competitive advantages. Our Quest Analytics SuiteTM (QASTM) includes features and capabilities that make it easy for you to standardize your data, build access analyses and create maps. You can also use the QAS to assess how competitive your network is through a disruption analysis. As a complement to the QAS, we developed QES Access Reporting.

When coupled with our Quest Enterprise Services, you take member access to the next level. It’s the next step into comprehensive access analysis that allows you to see and compare member access with the beneficiary files or your custom membership files. We also provide consulting services to help with regulatory submissions and data management.

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DELIVER ON TOMORROW’S GOALS BY PLANNING TODAY

We are committed to assisting you in your quest to achieve the Quadruple Aim – lowering costs and ensuring high quality of care while empowering patient and clinician experiences with actionable insights.

Schedule a consultative session with one of our health systems experts to discuss and determine your strategy.

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