ACCESS, ADEQUACY AND ACCURACY… TOGETHER
We Know That’s A Big ClaimOur solution has been developed in partnership with 95% of America’s Payers, The Centers for Medicare and Medicaid Services (CMS) and more than 30 state regulatory agencies, independent review organizations and benefit brokers to build provider networks, close adequacy gaps, correct data accuracy issues and monitor network performance over time. QES allows you to focus on maintaining compliance while creating a more differentiated network and providing better member experiences.
Included with QES:
PROVIDER NETWORK CONSULTING SERVICES
Project Management Oversight
Custom Prospect Provider Lists
Monthly Workgroup Meetings
Offload Your Work & Shift Priorities
AN ADEQUATE NETWORK REQUIRES ACCURATE PROVIDER DATA
Regulatory bodies across the country are emphasizing the importance of maintaining accurate provider data to ensure health consumer protection. We’re seeing them question a network’s validity and adequacy when inaccurate provider data is found in the public-facing directory. We understand, however, that achieving an accurate directory is not a simple task. That’s why we’re here to help.
Quest Enterprise Services is the only provider network management solution that brings adequacy and accuracy together in one platform – making it easy to see what’s right, wrong or missing from your provider data and linking those actionable insights into your network’s adequacy, highlighting variances and identifying gaps. We use multiple sources of verified data aggregated with our BetterDoctor Exchange and your own data – all at the provider level. And, by doing so, we provide you with the information you need to promote, demote or fix the data in your directory while reducing your regulatory risks.
“It’s just so head and shoulders above what we were doing before that nobody can even believe it’s real.”
—Manager of Provider Network Reporting,
National Health Plan
“An HSD report would take us a week and a half to put together. We’re doing it now in an hour—so that’s a pretty significant improvement.”
—AVP of Network Operations,
Large Metro Health Plan
Quest Enterprise Services does more than bring adequacy and accuracy into one solution. It also allows you to run what-if scenarios, targeting and terminating providers, to see the impact on your network so you can understand exactly where the opportunities are to expand your network. In addition, you can expand the opportunity analysis of your network using your membership to understand the true access to care and risks associated with poor access for your members.
It’s this type of flexibility that lets you differentiate your health plan, so you can take your provider network from adequate to excellent.
EXCELLENT NETWORKS REQUIRE DIFFERENTIATION
Achieving and maintaining network adequacy management is hard. We get it. And we’ve built solutions to help you achieve success while creating differentiated networks in the market.
DISCOVER THE ROI OF QUEST ENTERPRISE SERVICES
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.