Quest Enterprise ServicesTM (QESTM)

Provider Claims Insights

Through Claims Data Analysis, Improve network performance with the right providers

Remarkable Provider Data Insights

The providers you choose to include in your network significantly influence your medical spending, member satisfaction and administrative costs 

Network teams with access to additional provider insights such as quality, cost and clinical activity are better suited to build networks that meet business and member needs. Performance insights help teams avoid providers not participating in a line of business, those with high costs and concerning quality statistics.  

This data also allows you to compare current network providers to others within the market. 

Comprehensive Claims Data Analytics:

  • Data refreshed monthly  
  • 70-75% of total claims nationally  
  • Medicare-qualified entity access to 100% of Medicare claims data

Leverage robust provider insights within Quest Enterprise Services

Through Quest Analytics’ innovative Provider Claims Insights (PCI), your team can gain access to six provider performance measures, each fully integrated into the QES network, prospect and market files.  

You’ll be able to:

Reduce time to fill network gaps

Find the best provider to fill gaps

Improve the performance of your networks


To build a strong network, you need a comprehensive understanding of each provider in your network and market. 

Provider Claims Activity (PCA)
Understand provider’s clinical activity relative to other providers in their specialty and geographical locations across lines of business to avoid ghosts. 

Ghost (No patients)

Peripheral (Bottom 25% percentile of patient volume)

Standard (Middle 50% percentile of patient volume)

Core (Top 25% of patient volume)

Payer Mix

View and analyze providers’ claim volume broken down by payer and line of business. 

Effectiveness and efficiency Scoring (Quality and Cost)

Gain detailed and informative insights into relative performance among physicians by incorporating cost and quality scores.

Quality is measured at an individual practitioner level with 3 independent metrics

  • Mortality
  • Complications
  • Days in Acute Care (DAC)

Efficiency is measured at an individual practitioner/ HCO level with 2 independent metrics

  • Charges per Visit
  • Cost per Patient

Top Procedures and Conditions

Empower your teams to quickly and easily make informed decisions by leveraging the full range of expertise for each provider.

Delve deeper and find out whether the selected orthopedic surgeon treats hips or knees.

Increase the value of your Network

Save Money

$1000 savings in annual provider maintenance costs for every ghost provider removed from the network

Gain Efficiencies with Gap Filling

Reduce the time and cost to fill network gaps by 50% (est. $400 per gap)

Improve Member Experience

Reduce member churn through a higher quality network with fewer ghost providers

Gain Competitive Advantage​

Reduce administrative cost and speed time to market through more efficient gap filling

Improve Medical Loss Ratio (MLR)

Improve the quality and reduce the cost of your network


Our team is ready to help you discover how performance analytics can bring a new approach to your network builds — helping you get to market faster while improving member satisfaction.

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

Schedule Now