POWERING PROVIDER NETWORK MANAGEMENT
Quest Analytics empowers health plans of all sizes, provider groups and individual practitioners and state or federal regulators to design, optimize and manage their provider networks and data. So, they can tackle today’s toughest challenges head-on across their entire organization and business lines. While, consultants, benefit brokers and third-party administrators (TPAs) leverage Quest Analytics to increase the integrity of the networks they recommend to their clients. Whether you’re looking to maintain regulatory compliance with confidence or wanting to take your networks to the next level, we can help.
We Know Your Challenges
Let’s face it, today’s patchwork of regulations combined with new factors to consider like the quality of care, telehealth, surprise billing and social determinants of health (SDoH) can make gaining a competitive advantage seem insurmountable. That’s why Quest Analytics continually evolves with the industry to create the only enterprise solution that brings together real-time provider network adequacy and directory accuracy with member access. We streamline your organization’s efficiency and address regulatory compliance, provider directory data, network expansion and optimization.
We know your challenges and have tailored our solutions to help you achieve success.
Having an “Adequate” network is one thing but having an “Excellent” one requires thinking beyond time and distance analysis to understanding member access. Regulations and the provider landscape are dynamic and require knowledge of your provider networks (including breadth); the markets you serve; how members acquire care and how your organization will grow in the future.
If you’re looking to gain the extra edge in your market, our Quest Enterprise Services network management platform goes beyond adequacy analysis by giving you real-time actionable insights into:
- How a particular provider could fill or close gaps in your networks.
- How removing a provider impacts your network.
- What the level of effort and reward is for expansion opportunities
- How SDoH and telehealth could affect your networks.
- The depth, breadth and quality of your networks.
A critical piece that takes your provider network from adequate to excellent is understanding and managing provider data accuracy and its impact on your network adequacy.
Addressing the accuracy of your data is now mandated for all lines of business by both federal and state regulators to stop surprise billing, ensure consumer protections and, ultimately, improve your member’s experience.
With Quest Enterprise Services, we combine actionable insights into those critical auditable areas with verified data sources, including outreach and attestations through our BetterDoctor services, to identify quickly, address and prioritize high-risk challenges, including inspectors for data completeness, integrity, validity and more.
Member access is at the core of regulatory compliance and is the foundation for building an adequate network and maintaining a competitive advantage. Our Quest Analytics Suite makes geocoding your data, running access analyses and mapping member access easy. Our software can also provide in-depth disruption and quality analyses that help you get the complete picture of your membership’s access to care. And we offer a full complement of GeoAccess reports. It enables you to check the compliance boxes, while providing you with a competitive advantage to win RFPs.
When coupled with our Quest Enterprise Services, you take member access to the next level. It’s the next step into comprehensive access analysis that allows you to see and compare member access with the beneficiary files or your custom membership files. We also provide consulting services to help with regulatory submissions and data management.
Deliver on tomorrow’s goals by planning today
We are committed to assisting our clients in their quest for accurate provider directories and excellent health networks that maintain appropriate access to care for your members.
Schedule a consultative session with one of our network management experts to discuss and determine your strategy.
Book a Strategy Session