New Features & Enhancements in QES Accuracy
Quest Enterprise Services® (QES®) has been a trusted solution for managing provider data accuracy and network adequacy in one powerful platform. This unique integration has always set us apart, giving healthcare payers a streamlined way to handle compliance while ensuring high-performing networks. Now, with the release of new Quest Enterprise Services® (QES®) Accuracy features, we’re taking things even further.
Our latest enhancements are designed to provide faster, more robust data insights and actionable tools—helping you meet tight turnaround times and effectively address regulatory demands like the No Surprises Act, network reviews & audits, and other provider data accuracy regulations.
Accuracy Gap Analysis
QES Accuracy Gap Analysis brings a new capability to the table: It lets you easily see the before and after—what-if scenario—of how invalid provider data is impacting your network adequacy. With a click of a button, you can see the number of projected gaps, the impact on your adequacy score, and which field caused the gaps. Simply put, it helps you do more with less.
You can intelligently prioritize and accelerate your efforts to address your provider data to yield an immediate improvement in your network and its performance.
Your Real Risks, Revealed
How do we determine which provider’s data is inaccurate? We focus on the data elements whose accuracy can affect access to care and that regulators target:
- Provider Location and Number of Locations
- Number of Specialties and Suspect Specialties
- National Provider Identifier (NPI)
- Is the provider participating in Medicare Advantage
- Office of Inspector General (OIG) Exclusion List, and more
Accuracy Gap Analysis inspects these fields, finds and highlights providers that you should consider removing from your network, and creates a new view into the network showing its true, accuracy-adjusted adequacy score.
You’ll see the number of projected gaps caused by the inaccurate data, plus a breakout of all data errors by type:
- Address
- Specialty
- NPI
- Medicare Opt-Out
- Medicare Preclusion, and so on
This is invaluable information, and it’s available right now for all Quest Enterprise Services users.
Prioritize Your Response
Accuracy Gap Analysis arms you with the actionable insights you need to tackle data accuracy intelligently and methodically.
You can see which data errors will have the greatest impact on your members’ access to care and focus your initial efforts there. You can see which of several errors at a given location is most critical.
This is an accuracy gamechanger—and QES is the first and only solution to have it.
Tip:
Quest Enterprise Services Accuracy clients: Drill down into the accuracy-adjusted network to pinpoint specific provider details and actions that should be taken to correct each record. For example, missing or incomplete phone number, address, specialty.
QES Accuracy API Gives You More Speed and Automation
The new accuracy laws don’t penalize errors alone. They also mandate strict timelines for data verification and very short windows for getting data updates into your directories – just two days, in the case of the No Surprises Act.
Speed will clearly be essential to success going forward, and that’s where our Quest Enterprise Services Accuracy API comes into play. Our Accuracy API lets you retrieve your network provider data programmatically, with all data errors and changes identified. It is a complement to our Actionable Provider Report that focuses on the most critical error by location.
Retrieving this data through an API can significantly speed up your accuracy workflows because it allows you to create business-specific rules to address different categories of errors automatically—and even to update your directories automatically.
Stay Tuned for More Innovation
There you have it—the latest updates to QES Accuracy. We’re committed to keeping you ahead with continuous updates and enhancements. Keep an eye out for future developments as we deliver even more ways to streamline your operations and elevate provider data accuracy.
Elevate Your Provider Data Accuracy with QES Accuracy
Interested in learning more about the new features? Schedule a call with one of our experts today and see how QES Accuracy can make a difference for your team!
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.
