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New Accuracy Rules?  New Accuracy Tools

You’ve worked hard to build that provider network, and you’re proud that it meets all adequacy requirements. Now, in the name of more accurate provider directories, you’re working even harder to clean up your data.  And what will be your reward?

A network that could no longer meet adequacy requirements.

Unfortunately, there’s no getting around the fact that when you make changes to clean up your provider database, there’s a chance that a new specialty gap will open in your network—taking you from adequate to deficient. As you know best, the accuracy-adequacy link can sometimes feel like one step forward two steps back.

On the flip side, if you don’t correct your provider data, you could face hefty fines or penalties for failing to comply with federal and state provider data accuracy and transparency laws, like the No Surprises Act.

As always, Quest Analytics has your back. Read on to learn about our recent Quest Enterprise Services enhancements that provide you with faster access to powerful data insights and actionable tools to help you meet short turnaround timelines.

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 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 what 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.

 

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Pro 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.

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.

As Always, We’re Here To Help

If you’re already a Quest Analytics customer, you know our mission is to help health plans like yours deliver exceptional member experiences while taking the toughest regulations in stride.  Our Accuracy Gap Analysis and API enhancements are just two more ways we’re doing that

If you’re not yet a customer and think you’d like to know more, please request a demo. We’ll show you what our solutions can do for you—and what together we can do for your members.