OVERLAND PARK, KS, September 15, 2020 – Quest Analytics, the leader in provider network accuracy and adequacy solutions announced today the Centers for Medicare & Medicaid Services (CMS) has extended their contract with Quest Analytics for an additional five-year term to measure the adequacy of all Medicare Advantage Part C & D and Medicare-Medicaid Health Plans’ (MMP) provider, facility and pharmacy networks. This renewed contractual relationship builds on a decade-long relationship of developing leading innovations in the field of network management to ensure better access to care. The Quest Analytics product delivery also includes additional capabilities to measure and score accuracy for network submissions.
CMS regulations stipulate that “Health plans are required to maintain and monitor a network of appropriate providers, that is sufficient to provide adequate access to covered services to meet the needs of the population served[i]”. This means that plans must maintain an adequate network of health care providers, facilities, and pharmacies that are accurately listed in their Health Services Delivery Tables (HSD Tables). CMS reviews every health plan that applies, including MMPs annually. In addition, CMS reviews participating health plans every three years to ensure the network information submitted is accurate and determine whether the health plan meets the requirements for the number of providers per specialty within the designated time and distance criteria. The review process is applied to 40 specialties and facilities. The time and distance criteria are defined according to five county types based on population density. CMS uses Quest Analytics solutions to score plans against the standards and to inform them of any noncompliance issues.
“We are proud of the trust CMS places in Quest Analytics to provide the agency with the solution they need to measure the network adequacy and provider directory accuracy across all federally regulated plans,” said Steve Levin, Chief Executive Officer, Quest Analytics. “As an organization, we are aligned with CMS and committed to improving access to care with better data that enables better networks.”
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Quest Analytics offers a comprehensive platform that enables health plans to optimize their member experience while complying with federal and state regulations for network adequacy and provider directory accuracy. Quest Enterprise Services include provider data accuracy management and network analytics solutions that enable the nation’s leading health plans, insurance regulatory agencies, and benefits consultants to measure, manage and monitor their network data to maximize efficiencies. For more information, talk with one of our network management experts today.
[I] Centers for Medicare & Medicaid Services Medicare Advantage and Section 1876 Cost Plan Network Adequacy Guidance