Innovation is essential in tackling the challenges of provider data accuracy. With the latest enhancements to Quest Enterprise Services® (QES®) Accuracy, you’ll find greater data transparency, improved network visibility, and enhanced operational efficiency. These updates not only make it easier to stay compliant with regulatory requirements but also give you a clearer understanding of your provider data. Let’s explore what’s new!
New Features & Enhancements in QES Accuracy
New Provider Data Fields
To support new and upcoming regulations—like tracking appointment wait times and telehealth services—we’ve added provider data elements to enhance your attestation insights.
Appointment Wait Time
Gain insights into the average appointment wait times for various types of care:
- Preventive Care
- Routine/Diagnostic Care
- Specialty Care
- Urgent Care/Acute Illness
Provider Telehealth Modality and Originating Site
As telehealth grows in importance, so does the need to understand provider offerings at the practitioner-at-location level. With this new data, you can understand:
- Telehealth Modalities: The types of telehealth communication offered by a provider, such as Audio Only, Audio Video (AV), Asynchronous Store & Forward, or Text/SMS Chat.
- Originating Site: Details on where the patient is located. For example, at home, in a clinic, or in another environment such as a nursing home.
QES Provider Profile Fly-Out
Both Appointment Wait Times and Telehealth data are conveniently located in the Provider Profile Fly-Out, offering a centralized view of critical provider details.
Provider Outreach Metrics: Last Attested Date & Days Nonresponsive
Provider directory requirements, such as those outlined in the No Surprises Act, mandate the removal of providers from directories if they fail to verify their information within a specified timeframe. Additionally, as part of provider directory audits, regulations are increasingly requiring health plans to submit detailed metrics on provider outreach and verification efforts, along with their network data.
To support compliance and streamline processes, we’ve introduced two additional metrics to enhance your visibility into provider outreach efforts and responsiveness.
New Provider Outreach Metrics
- Days Nonresponsive: The number of days a provider has been unresponsive to outreach efforts.
- Last Attested Date: The last time the provider verified their information.
These metrics—combined with existing ones like Last Outreach Date, Last Outreach Method, Last Attestation Method, and Outreach Eligibility—help you:
- Identify unresponsive providers requiring follow-up.
- Detect trends in provider responsiveness over time.
- Proactively address risks impacting regulatory reporting.
- Maintain compliance in your provider directory processes.
Example: Proactive Risk Mitigation
Imagine a provider has been unresponsive for over 90 days. With QES Accuracy, you can:
- Escalate outreach efforts with formal notifications and reminders.
- Reevaluate network adequacy to determine if gaps exist without the provider.
By using these actionable insights, you can mitigate compliance risks effectively and ensure reliable network performance.
90-Day Attestation Rate Reporting
To enhance your understanding of provider attestation and network trends, we’ve introduced a new 90-day analysis window. This view provides an alternative perspective to complement the existing 365-day view—offering greater flexibility in evaluating your network and alignment with compliance requirements.
Elevate Your Provider Data Accuracy with QES Accuracy
There you have it—the latest updates to QES Accuracy. Stay tuned for more enhancements as we keep bringing you solutions designed to help your organization thrive.
Ready to explore the latest features?
Schedule a call with one of our experts today and see how QES Accuracy can make a difference for your team!
Related Provider Data Accuracy Resources
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.
