Need help keeping up with industry regulations?
Healthcare provider networks are under intensifying scrutiny, especially regarding provider data accuracy.
Quest AnalyticsTM is here to help you improve the integrity of your provider data. We recognize the challenges of maintaining accurate provider data – a task that is further complicated by the need to handle evolving regulations, timely provider outreach, integrating changes and bridging internal silos, all while managing a wide range of other competing priorities. It is an enormous undertaking that can be challenging to manage without the right tools and services and can create:
- Reduction in Quality Rankings
- Decreased member satisfaction and retention
- Inefficient operational processes
OUR UNIQUE QES ACCURACY METHODOLOGY IS DESIGNED TO HELP
We provide a closed-loop, outreach-driven approach that helps you improve provider data accuracy.
Integrated into our Quest Enterprise Services (QES) network management platform, our unparalleled approach starts with your network information and provides targeted and actionable recommendations to enhance data quality.
*Confidence scoring through machine learning coming soon.
LOOKING TO SIMPLIFY YOUR PROVIDER OUTREACH PROCESSES?
Leverage our proven attester-driven solution
The process for provider attestation is cumbersome and time-consuming. With QES Accuracy, this process becomes easier and more efficient. Our approach includes outreach that facilitates provider information updates—helping you continually update provider data, meet compliance, analyze multiple networks and enhance the member experience in a single platform.
We help you achieve improved attestation rates and community-based data insights by utilizing:
- Rolling 90-day, attester-driven outreach to providers
- Multi-modal outreach to ensure that all providers are contacted
- Pre-populated proprietary provider portal with known data
- Location-centric approach to address provider directory errors
- Co-branded outreach with BetterDoctor trusted brand
- Multiple channels and sources for data updates, including provider portal and rosters
Data Inspection Categories
- Completeness – Are critical attributes present in the data?
- Eligibility – Are the NPIs valid or under sanctions?
- Validity – Have the attributes been verified?
- Integrity – Are the attributes realistic (i.e., excessive addresses or specialties)
- Standardization – Are the attributes in the standard format?
- Enrichments – Is there additional verified information available that wasn’t available in your data?
LOOKING TO ENHANCE YOUR DATA INTEGRITY?
We put your data to the test with seven data inspectors enabling you to quickly identify what’s right, wrong, missing and changed in your data.
LOOKING FOR ACTIONABLE INSIGHTS TO MAKE MORE STRATEGIC NETWORK DECISIONS?
QES helps you prioritize your team’s time around the providers that will most impact the adequacy of your network and the accuracy of your provider directory.
Our Accuracy Services is integrated into our QES Network Management platform enabling you to efficiently identify the critical data needing attention and streamline your data remediation process. It allows you to have a better understanding of where to start and how to prioritize your tasks, making it easier to manage your workflows effectively.
QES helps you save time and effort by breaking down complex data into bite-sized pieces, so you can work on important sections first and keep your network running smoothly.
LOOKING TO IMPROVE YOUR WORKFLOW?
QES Accuracy API allows you to automate data retrieval programmatically and easily identify all the specific provider data attributes that need to be updated in your system.
You will receive a more detailed breakdown of all data attributes, including suggested actions to take.
By pulling your data faster and seeing the corrections needed, Accuracy APIs help you meet the quick turnaround requirements listed in the No Surprises Act.
Our secure REST Accuracy API lets you retrieve your network provider data programmatically, with a comprehensive view of the latest information for your providers, along with the verification date and source.
QES Accuracy API gives you the flexibility and accessibility needed to keep provider directory information up to date.
QES Accuracy Services provides the tools and services you need intersecting efficiency improvements, compliance confidence and actionable data insights.
Automated Process Efficiencies
Reduce outreach efforts, improve attestation response rates and streamline your processes.
Improved Compliance Confidence
Reduce risk of penalties associated with member complaints by keeping your provider directory up-to-date and accurate.
Simplified Reviews and Processes
Eliminate the need for multi-system reconciliations and streamline data change process through API.
Proven Solutions for Your Provider Network Management
Looking to simplify your workload? Let Quest Analytics take on the heavy lifting! Our solutions and dedicated team specialize in provider data accuracy and provider network adequacy for various lines of businesses, including Medicare Advantage, Medicaid, Exchange and Commercial. Schedule a strategy session today and see how we can help you every step of the way.