How Provider Claims Insights Can Improve Your Provider Network Management

Find the Right Providers with Quest Enterprise Services Provider Claims Insights

Who are Your MVPs? Find The Right Providers with Quest Enterprise Services Provider Claims Insights.

As an insurance provider, your primary goal is to connect your members with reliable and available healthcare services. So, it’s frustrating when you try to do so but end up with ghost providers who disappear and disappoint your members. Is there a way to avoid this? Yes! Quest Enterprise Services Provider Claims Insights is here to help you.

What is Provider Claims Insights?

Data Insights to Help You Create and Maintain High-Performance Networks

Provider Claims Insights provides you with key information to compare and analyze providers based on patient volume, geography, and specialty. With this comprehensive understanding of each provider in your network and the market, you can ensure your members have access to quality care.

How Does Quest Analytics Help Eliminate Ghost Providers in Your Network?

Eliza Hoffman shares how Quest Analytics tackles ghost providers and networks head-on. Through advanced automation and actionable data insights, we give you quick access to key information that enables you to create and maintain high-performance networks.

What Are The Benefits of QES Provider Claims Insights?

The Benefits of QES Provider Claims Insights for Your Provider Network Management

Traditional data analysis can be tedious and time-consuming. QES Provider Claims Insights offers a powerful combination of data insights, automation, and expert guidance that brings many benefits to your provider network management.

Pinpoint Who Is Active, Who Is a Ghost Provider, and Who Is In Between

The insights give you a clear picture of which providers are actively seeing patients, which ones are ghosts, and which ones are in between. With this information, you can stay on top of provider changes, smartly manage your networks, fine-tune your provider mix, and ensure your members receive superior healthcare services.

Gain Visibility into Provider Program Participation

Understanding a provider’s compliance with time and distance standards is essential but it’s only part of the story. To truly assess a provider’s activity level and suitability for your specific network, you need to know more. With QES Provider Claims Insights you gain valuable information like whether a provider participates in Medicare Advantage, Medicaid, or Commercial programs

Key Information Provided

  • Is this provider seeing patients?
  • What line of business is this provider in?
  • How efficient and effective is this provider?

This increased visibility of valuable information helps you make informed decisions that align with your organization’s goals. Whether you’re trying to fill gaps in your network or grow your business, QES Provider Claims Insights empowers you with the tools required to identify the right providers for your needs.

Increase Network Performance With New Levels of Insight 

Experience new levels of data insights to better understand how your network is performing at both the provider and network levels. Our top-notch data analytics can help you spot tricky ghost providers and discover gaps in your network that you didn’t know existed. Once you find these missing pieces, you can take action and improve your network.

Plus, you’ll have the information to know exactly who is available to fill the gap and who isn’t. No more wasting precious time on possibly recruiting a ghost provider. We give you the power to strategically decide which providers can make a real difference and move the needle. 

What Are the QES Provider Claims Insights Provider Designations?

4 Categories to Easily Understand Provider Activity Level

QES Provider Claims Insights uses a data-driven approach to group providers into four categories.

  1. Ghost
  2. Peripheral
  3. Standard
  4. Core

These designations are calculated based on the combination of state, specialty, and number of patients. Let’s take a closer look at each category. 

Ghost Providers

Providers listed in your data but have zero patient claims. 

Peripheral Providers

Are they billing? Sure. But they are only seeing the bottom 25% of patient volume. They could be the new kids on the block trying to make a name for themselves. Or maybe they’re slowing down. 

Standard Providers

Providers with the middle 50% of patient volume.

Core Providers

Providers with the top 25% of patient volume. 


Identify ghost providers and optimize the value of your network, by ensuring it’s adequate, accurate, and active with Quest Analytics.

More Resources on Ghost Networks

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 and Commercial. Schedule a strategy session today and see how we can help you every step of the way.

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