You’ve got increasing network adequacy risks — and a constant scramble to stay compliant.
You’ve got new risks for surprise billing and directory accuracy — and no easy way to find and fix data problems.
And you’ve got enterprise silos — across product lines and departments — that undermine efficiency.
Quest Enterprise Services is an entirely new approach to provider network management.
It’s a self-service SaaS platform designed to span and unite the enterprise, taking management out of the silos and bringing powerful new capabilities to your entire organization.
It lets you see and work across product lines and departments, sharing data and resources, eliminating duplicate effort, and dramatically increasing efficiency.
And it gives you the tools you need to measure, manage and monitor critical measures of performance, helping you reduce regulatory risks, build better networks and deliver better member experiences.
Adequacy + Accuracy
in One Platform
CMS directory audits over the past few years have highlighted a fact health plans can no longer ignore: Network adequacy and directory accuracy are inextricably linked. You can’t treat them as separate issues. And if you try to solve one independently of the other, you’re likely to fail.
Quest Enterprise Services. It’s the first and only network management platform designed to measure variances in adequacy and accuracy together — simultaneously — at the network and directory levels, where you get audited.
It measures network adequacy exactly the way regulators do — because CMS and many states use our tools in their audits. So it finds the same gaps they would find.
It measures directory accuracy by leveraging a highly accurate source of truth nobody else has: our BetterDoctor Exchange, a national database of primary-sourced, continuously updated data from more than half a million active providers — and growing. That’s how we can measure accuracy when others can’t. At a glance, you’ll know what’s right, what’s wrong and what’s missing.
Manage & Monitor Together
And when you can measure these key performance indicators, you can finally manage them, efficiently, using powerful new tools to close adequacy gaps and correct accuracy issues. You can monitor performance over time to guide your management efforts.
The result is not just compliant networks, accurate directories and better member experiences; it’s a stronger, smarter and more competitive organization overall.
"Does our Medicare Advantage network meet CMS adequacy standards overall? By specialty and by county?"
"How accurate is our data? Where are we introducing errors? Is it our process? Our data sources? Are we more accurate this month than last?"
"How do I prioritize recruitment to fill gaps most efficiently? What happens to my adequacy if I lose my biggest practice?"
"Which counties represent the best opportunities to expand our Medicare Advantage network based on our provider footprint?"
"How does my network compare against the total available providers in the market for each specialty?"
Actionable Insights Across the Enterprise
Enterprise-wide management means more than connecting silos and streamlining the workflow.
It means giving everyone in your organization, regardless of product line or job function, access to the tools and insights they need to work more intelligently and more proactively.
And it means for the first time being able to ask — and answer — fundamental questions that will transform the way you work.