Quest Enterprise Services

PROVIDER NETWORK MANAGEMENT EVOLVED

Provider Network Management: Fix inaccurate data, adjust network adequacy, improved member experience.

ACCESS, ADEQUACY AND ACCURACY… TOGETHER

Quest Enterprise Services (QES) is the only self-service SaaS platform that allows you to analyze, manage and report on your member access, provider network adequacy and directory accuracy in real-time, in a single solution, across your entire organization and all lines of business. It’s how you evolve your provider network management from adequate to excellent.

WE KNOW THAT’S A BIG CLAIM.

But our solution has been developed in partnership with 95% of America’s health plans, The Centers for Medicare and Medicaid Services (CMS) and more than 30 different state regulatory agencies, independent review organizations and benefit brokers to develop networks, close adequacy gaps, correct accuracy issues and monitor network performance over time. QES allows you to focus on building a more differentiated network with better member experiences.

Quest Enterprise Services: Provider Network Adequacy and Provider Directory Accuracy.

AN ADEQUATE NETWORK REQUIRES ACCURATE PROVIDER DATA

Regulatory bodies across the country are highlighting the accuracy of provider directories as an important factor in your network’s validity and adequacy. It’s also critical to ensuring consumer protections. Many times achieving an accurate directory is a sisyphean task? We’re here to help.

Quest Enterprise Services is the only provider network management solution that brings adequacy and accuracy together in one platform – making it easy to see what’s right, wrong or missing from your provider data and linking those actionable insights into your network’s adequacy, highlighting variances and identifying gaps. We use multiple sources of verified data aggregated with our BetterDoctor Exchange and your own data – all at the provider level. And, by doing so, we provide you with the information you need to promote, demote or fix the data in your directory while reducing your regulatory risks.

“It’s just so head and shoulders above what we were doing before that nobody can even believe it’s real.”

—Manager of Provider Network Reporting,
National Health Plan

“An HSD report would take us a week and a half to put together. We’re doing it now in an hour—so that’s a pretty significant improvement.”

—AVP of Network Operations,
Large Metro Health Plan

EXCELLENT NETWORKS REQUIRE DIFFERENTIATION

Achieving and maintaining network adequacy management is hard. We get it. And we’ve built solutions to help you achieve success while creating differentiated networks in the market.
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Quest Enterprise Services does more than bring adequacy and accuracy into one solution. It also allows you to run what-if scenarios, targeting and terminating providers, to see the impact on your network so you can understand exactly where the opportunities are to expand your network. In addition, you can expand the opportunity analysis of your network using your membership to understand the true access to care and risks associated with poor access for your members.

It’s this type of flexibility that lets you differentiate your health plan, so you can take your provider network from adequate to excellent.

Deliver on tomorrow’s goals by planning today

We are committed to assisting our customers in their quest for accurate provider directories and adequate 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