First to launch platform enabling health plans to simultaneously measure, manage and monitor network adequacy AND directory accuracy.
OVERLAND PARK, Kan., June 16, 2020 – Quest Analytics, the leader in measuring, managing and monitoring health plan network performance, today announced the release of Quest Enterprise Services (QES), the first and only platform to enable the health plan community to demonstrably improve compliance with federal and state network adequacy and directory accuracy regulations, reduce the likelihood of surprise billing, and, in the process, substantially improve the health plan member experience.
In its 2020 call letter, CMS noted that: “Inaccurate provider directories may impede access to care and bring into question the adequacy and validity of the [plan’s] provider network.”1 The CMS audit of Medicare Advantage plan directories found that for the majority of plans, 30-60% of provider locations were inaccurate either because the provider did not work at the location or because the provider did not accept the plan at the location.2
“At Quest Analytics, we agree with CMS and understand that adequacy and accuracy are inextricably linked. We developed Quest Enterprise Services in direct response to CMS’ observation,” said Steve Levin, Chief Executive Officer, Quest Analytics. “We are announcing the release of QES with over 80 national, state and local health plan customers on the platform today. These health plans can improve both the accuracy of their provider data AND the adequacy of their networks on a single platform, so that their members can enjoy access to an adequate network of care and reduce surprise billing events. When a QES health plan member searches for a provider in a plan directory, the name, specialty, address and phone numbers will finally be correct.”
Many health plan networks fail to meet minimum standards for network adequacy and directory accuracy. The Quest Enterprise Services platform enables plans to accomplish three important objectives:
- Measure: Health plans can measure network adequacy and directory accuracy — at the health plan segment, product, network, provider, specialty and geographic level.
- Manage: Health plans can identify gaps in network adequacy, and directory inaccuracies, and use the Quest Enterprise Services to remediate the variance.
- Monitor: Health plans can trend network performance for both network adequacy and directory accuracy to monitor progress internally and demonstrate progress to federal and state agencies.
“You can’t manage what you don’t measure,” said John Weis, President and co-founder, Quest Analytics. “By integrating our data and insights into a health plan’s workflow, Quest Enterprise Services enables an entirely new approach to network performance management that will help build a more responsive, better-designed system of care.”
About Quest Analytics
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 accuracy management and network analytics solutions that enable the nation’s leading health plans, insurance regulatory agencies and benefit consultants to measure, manage and monitor their network data to maximize efficiencies. For more information, please visit www.questanalytics.com.
[1] CMS Announcement of Calendar Year (CY) 2020 Medicare Advantage Capitation Rates and Medicare Advantage and Part D Payment Policies and Final Call Letter, p 192
[2] CMS 2018 Online Provider Directory Review Report, p 1.
