Quest Enterprise Services (QES)
Streamline Your Termination Analysis
Bringing Efficiency To Your Termination Workflow
Your Current Process
Terminating large groups of providers from your network one at a time can be a time-consuming process – especially if you are provided limited Tax ID or NPI information. You have to dig into your network, locate the missing data, then terminate providers at the county, specialty or project level to see the impact on your network adequacy. Then you repeat the process for another provider. This works great if you’re looking to run an analysis on one or two providers, but it’s highly inefficient with little strategic upside when terminating a large group of providers.
Your Improved Process
Quest Analytics Volume Terminations is built for large group termination impact analysis. No more picking through your network one provider at a time, one project at a time. With this Quest Analytics Volume Terminations, you can:
- Perform a group lookup across selected projects, all counties, and all specialties
- Upload a list of Tax IDs and NPIs by county and specialty
- Run termination reports against projects you choose from your QES Dashboard
- Receive a termination time slice that reports on created gaps and gaps by specialty group
Volume Terminations are a more efficient way to clarify your post-termination position in the market, reduce regulatory risk, win, and maintain more RFPs, and make more informed decisions around ensuring your member’s access to care. You’ll also gain strategic insights you can leverage during negotiations by understanding how current and future provider contracts impact your network adequacy.
You can easily run ‘what-if’ scenarios to see if a gap would be created if you removed a group or a variety of providers from your network for things such as CMS compliance. Multiple volume termination simulations can quickly be performed to determine what will happen if a volume termination is performed against another set of providers from your network.
Once you’ve run your what-if simulations, you’ll want to analyze the data. QES Volume Terminations includes in-depth reporting to help you collaborate with your team and make those strategic next steps. This saves you time in having to research any gaps that may or may not have opened.
Report outputs include:
Projected Terminated Providers
List of NPI/TINs that were used to run the volume termination.
Volume Termination Project Details
Information about the project the Volume Termination was run against, whether records were terminated, and the number of gaps created
Terminated Network Service Area Changed Gaps
Before and after Volume Termination results for affected specialties or counties.
Terminated Network Service Area Providers
List of in-network providers or facilities that were terminated in the projects.
Due to the sensitive nature of termination analysis, access security is managed by role and assigned at the user level. This role-based add-on feature allows clients to run Volume Termination analysis across multiple projects. There are two role-based access levels:
Termination viewers can see the termination time slice in a trend graph. They can also see which providers have been terminated.
In addition to the termination viewer privileges, the termination administrator can perform termination scenarios. After the role is set up, termination administrators have an option for termination on their QES dashboard. There is a built-in wizard that guides the termination administrator thru the workflow.
Deliver on tomorrow’s goals by planning today
We are committed to assisting our customers in their quest for accurate provider directories and adequate health networks that maintain appropriate access to care for your members.
Schedule a consultative session with one of our network management experts to discuss and determine your strategy.
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