Quest Enterprise Services® (QES®)
EXCEPTIONS PACKAGE
Streamline Network Adequacy Exception Requests
The Smart Way to Manage Network Adequacy Exceptions
Simplify how you handle network adequacy exceptions with a faster, smarter, and more efficient approach. With Quest Enterprise Services® (QES®) Exceptions Package, you’ll generate network adequacy exception requests tailored for regulatory submissions, access compliance-ready insights required by regulators, and manage everything in one centralized platform, QES.
With the additional capabilities of Exception Request Document Generator, Pattern of Care Provider Documentation, Zip Summary, Next Closest Provider, Next Closest Prospect Provider, Verified Sources, and Shared Insights, you gain instant access to the network, membership, and market intelligence that you need to create compelling exception narratives quickly and efficiently.
QES Exceptions Package streamlines every aspect of your exception request process. From understanding provider details to analyzing network adequacy, you can efficiently oversee tasks, track progress, communicate with team members, and find market insights—all in one place.
CMS Exception Request Document Generator
Automatically generate CMS Medicare Advantage Network Adequacy Exception Request documents by auto-populating key details from QES.
Zip Code Summary
Quickly identify where the network adequacy Pass/Fail is occurring at the zip code level within each county. Easily see the percentage of members who are with and without access.
Next Closest Network Provider
When submitting an exception request to regulators, you must provide information on which providers beneficiaries can see if they have to travel outside the standard requirements. Ultimately, regulators are looking to determine the next closest provider for the beneficiaries without access. The Next Closest Network Provider feature shows you the distance and/or time to the next closest in-network provider when network providers are not available within the regulatory requirements.
Next Closest Market and Prospect Provider
Sometimes, the next closest provider is not in-network. With Next Closest Market Provider and Next Closest Prospect Provider, you’ll easily identify which Market or Prospect providers are closer for your members or the state-provided census than in-network providers.
Pattern of Care Providers
Efficiently add providers to HSD tables for network submission, in support of CMS network adequacy exception narratives, helping to identify providers who can deliver care to members outside the time and distance standards, while demonstrating proactive efforts to maintain member care to meet network adequacy standards.
Verified Sources List
When using Market or Prospect providers in your exception request, you need to indicate which sources you’ve used to identify their information. QES Exceptions Package allows you to simply select your sources from a drop-down list and then export it for the required form. Further making it easier than ever to compile the information needed for your exception.
Shared Insights for Network Gaps and Exceptions
Understand whether your network gaps are unique or part of broader trends with Shared Insights. View de-identified gap data and exception submission patterns from other payers in your markets, evaluate approval data from previous years, and access crowdsourced intelligence to prioritize your efforts effectively.
Track, Manage and Report Exceptions, All In One Place
Monitor every step of the exception process from start to finish in a single platform. Easily track requests through the following stages:
- Pending
- Submitted
- Approved or Denied
- Appealed
Related Resources
Advance Your Exception Strategy
The QES® Exceptions Package helps you handle network adequacy exceptions year-round, giving you the tools and insights to save time, get approved, and deliver results. Talk to one of our experts today to learn more about how these capabilities can transform your network adequacy process.