Quest Analytics Launches Provider Claims Insights Integrated into Quest Enterprise Services
Quest Analytics, the leader in provider network management solutions and services, today announced the launch of Provider Claims Insights. This new offering adds provider performance measures within the Quest Enterprise ServicesTM (QESTM) platform to help health plans improve provider selection and overall network performance. Quest Enterprise Services Provider Claims Insights gives network teams the tools […]
Quest Analytics to Showcase Provider Data Integrity Solutions at AHIP 2023
Quest Analytics, the leader in provider network management solutions and services, will attend AHIP 2023 this week and showcase its Accuracy Services Solution, a part of Quest Enterprise ServicesTM (QESTM). Quest Analytics’ Accuracy Services is the industry’s leading solution for provider data accuracy, uniquely linking regulatory compliance with a health plan’s member experience, network integrity […]
Creating an Effective Provider Data Management Strategy
It is Friday afternoon, and all you can think about is getting out on the green tomorrow at the top-notch golf course everyone talks about. The only problem is scoring a coveted Saturday tee time takes serious planning skills. If you have not booked it already, forget about it. You might as well plan to […]
Top Trends For Provider Data Management
Summer is here, and we don’t want you to spend it working long hours behind your computer. That’s exactly why we’re sharing the latest Provider Data Management trends that will help you knock out your To-Do list, enhance teamwork, and streamline your provider data management process. With more time on your hands, you’ll be free […]
Provider Data Management Tips to Successfully Meet the No Surprises Act
We know the No Surprises Act can be a bit confusing, but no worries, we’re here to help. In this blog post, we’ll be sharing some insider insights and provider data management tips for health plans like yours on how to meet the provider directory requirements of the No Surprises Act. Let’s dive in and […]
Four Pillars to Guide the Success of the National Directory of Healthcare Providers and Services
Consideration for Establishing a National Directory of Healthcare Providers and Services The Centers for Medicare & Medicaid Services (CMS) released a Request for Information (RFI) seeking feedback on establishing the first national directory of healthcare providers and services (NDH) that could serve as a centralized data hub for healthcare provider, facility, and entity directory information […]
Policy Trends Across Health Insurance Markets
EVOLVING HEALTHCARE POLICY LANDSCAPE FOR NETWORK ADEQUACY Regulators and policymakers continue to make changes that strengthen federal and state oversight processes for Medicare Advantage, Marketplace, and Medicaid Health Plans. Let’s look at what’s happening in each market. Medicare Advantage: Network Adequacy Requirements for Applications In a previous blog post, we discussed how the Centers for Medicare […]
No Surprises Act Provider Directory Enforcement Guidance for Regulators
Section 116 of the No Surprises Act (NSA) requires health plans to establish a provider directory verification process and a procedure for removing providers or facilities with unverifiable information. No less than once every 90 days, health plans must verify and update their provider directory database. Within 2 business days of receiving a provider update, […]
New Accuracy Rules? New Accuracy Tools
Accuracy Gap Analysis Quest Enterprise Services—QES—has always allowed you to manage provider data accuracy and network adequacy together, which is one of the aspects that sets us apart from other solutions in the industry. Our Accuracy Gap Analysis brings a new capability to the table: It lets you easily see the before and after—what-if scenario—of how […]
What is Provider Data Validation – Are You in Compliance?
WHAT IS PROVIDER DATA VALIDATION? Provider data validation (sometimes referred to as provider data verification or attestation) is a process where health plans confirm each participating provider’s contact and other information displayed in the public provider directory is correct or incorrect. The goal is to update and maintain their provider data to prevent incorrect provider […]
