Imagine this: You’re responsible for managing a network of healthcare providers, and one day you check your inbox – there it is – an urgent email from top executives at your company asking for your help. They’re considering ending the agreements with a few providers by June 30th of this year and they need to know how this decision will affect the business. They’re counting on you to provide critical information about the impact this will have on all the provider networks and lines of business.
The problem is the only information they provided you is the National Provider Identifier (NPI) and Tax Identification Number (TIN) of the providers.
Your mind starts to race as you envision yourself sifting through mountains of data, trying to find the proverbial needle in a haystack. You feel like you are about to play a big game of Where’s Waldo, but the stakes are much higher.
You take a deep breath and mentally prepare yourself for taking on this new project. You start thinking about the information you will need to find, everything from:
- Who are these providers?
- What specialty do they practice?
- Do they practice at multiple locations?
- Are they contracted across multiple networks and/or programs?
- How do we ensure our networks are not significantly impacted if we end the agreements?
And that’s just the start. Once you identify the providers, you still need to unravel the mystery of what happens if they leave. This includes analyzing the members who will be impacted, calculating the effect on various lines of business and determining how it affects your coverage. It’s a tedious and time-consuming task, one that traditionally requires a ton of manual effort.
Wouldn’t it be nice if there was an easier way? Well, great news daydreamer—there is! Quest Enterprise Services (QES) is here to save the day with Volume Terminations.
What is QES Volume Terminations?
Know the Impact. Act in the Present. Plan for the Future.
QES Volume Terminations empowers you to proactively plan for growth and success with your provider networks. It brings automation and powerful analytics into the mix, helping you quickly evaluate the impact of removing a provider or provider group across all networks and lines of business, including Medicare Advantage, Medicaid and Commercial.
Simply put, QES Volume Terminations provides a crystal ball that can help you master provider network management with a newfound level of speed, analytics and precision. Let’s dive into the main ways in which QES Volume Terminations can turbocharge your provider network management.
Go from a “Where’s Waldo” Approach to Having a Powerful Crystal Ball.
What Can QES Volume Terminations do for your provider network management?
Speed, Analytics and Precision
Oh, the constant changes in a provider network! At times, it can make you feel uncertain and powerless. We’re here to change that. With QES Volume Terminations, you can finally take a deep breath and reclaim a sense of readiness.
Using our fast-track approach, you can plan your network proactively and make informed decisions about which providers or provider groups to terminate. Through actionable data analytics, you can experience the ease and convenience of measuring the impact of removing a list of NPIs or TINs from all your provider networks and lines of business, simultaneously. What’s even better, if you only have the NPI or the TIN, that’s okay—that’s all you need to generate the same powerful insights.
In four simple steps, you’ll know:
- The specialties, counties and lines of business affected by the provider’s termination.
- The number of gaps created in each network the provider participates in.
- Your network adequacy score for both your current and projected networks.
With quick and efficient results, you can say adios to hours of cross-referencing databases and sacrificing sleep to stay ahead. QES Volume Terminations will do the heavy lifting for you, leaving you with more time to revel in your freedom.
Pro Tip: Looking to impress the higher-ups with some smart tactics? Try using QES Volume Targeting to locate providers who can fill the gap before the termination hits. It’s a pro tip that’s sure to catch some attention and show off your savvy problem-solving skills.
Automate What-If Scenarios
When it comes to managing provider networks, your time is valuable. With QES Volume Terminations, you can easily run simultaneous “what-if” scenarios to see how changes to your current provider network will affect your coverage. What’s more, this powerful tool can run multiple scenarios in mere seconds, enabling you to make decisions fast, without wasting precious hours or even days.
Can you imagine being able to accurately predict the outcomes of your provider contract decisions before they happen? This kind of advanced insight can transform the way you manage your network, giving you the power to make better-informed decisions that can positively impact your bottom line.
Plus, by automating the process of scenario planning, you’re able to free up time and resources for your team to focus on implementing the best strategies for your provider network.
Negotiation with Powerful Insight
Negotiations can be tricky, but with QES Volume Terminations, you’ll have a wealth of insight at your fingertips. You’ll be equipped with the analytics to see just how much weight they carry when it comes to contributing to your network. Can you picture yourself walking into that negotiation, head held high, armed with the knowledge you need to make the best decision for your organization? No more hesitating or second-guessing the conversation, you’ll have the data and insights to back up your decisions.
Avoid Compliance Hurdles
At this point, you’re saving time—you put the Where’s Waldo approach on the shelf—you’re getting sleep and facilitating key strategic decisions. But hold on, there’s more! We want you to know just how much we care by incorporating compliance features that will make your life even easier. QES Volume Terminations gives you the automation and data insights to conquer compliance and regulatory requirements related to network changes by identifying specialty gaps and proactively avoiding compliance hurdles like never before.
- What would my network look like if I remove providers who haven’t recently attested to their information?
- What would my network look like if I remove providers who have more than 10 locations?
- What would my network look like if I remove all the ghost providers?
This kind of foresight is priceless in the healthcare industry, where anticipating and preventing issues can determine whether you sink or swim. And, we want you to swim!
Manage Your Provider Network with Ease and Efficiency
QES Volume Terminations isn’t just a necessity – it’s an absolute must-have for any healthcare network looking to thrive in today’s complex landscape. With QES Volume Terminations, you have the power to manage your healthcare provider network with ease and efficiency, ensuring maximum value to all stakeholders.
Say goodbye to the Waldo-style hunt and simplify your network management with just a few clicks. QES is a simple-to-use network solution that makes your life easier, ensuring more time-efficient and smarter strategic decision-making. So the next time you receive a message from your CFO, you can confidently say, “I got this.” Or, in the words of Olivia Pope, “It’s handled” with QES Volume Terminations.
Learn More About QES Volume Actions Package
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.