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Payers & Plans

TAKE CHARGE OF YOUR PROVIDER NETWORK MANAGEMENT CHALLENGES

YOUR PARTNER WITH UNRIVALED EXPERIENCE

It can’t simply be about checking boxes and maintaining compliance anymore. Health plans and health systems have to deliver high-quality, differentiated care. We can help you differentiate your networks with in-depth insights into the specialties of the physicians you work with and the access to care your members receive. Our self-service SaaS platform gives you a competitive edge by allowing you to analyze, manage and report on your provider network adequacy and provider data accuracy across your entire organization and all lines of business, and it does all that in a single solution—something no one else can offer.

Additionally, Quest Enterprise Services (QES) helps you respond confidently to accreditation agency requests, such as NCQA and URAC, with the ability to demonstrate an ongoing process for improvement and provide a real-time view of your network’s performance over time for primary care, behavioral healthcare, specialty care practitioners, facilities and more.

MAINTAINING REGULATORY COMPLIANCE

Quest Enterprise ServicesTM. It’s the first and only network management platform designed to take networks from adequate to excellent by measuring variances in adequacy and accuracy together — simultaneously — at the network and directory levels, where you get audited. And, because CMS, state insurance and Medicaid departments use our tools in their monitoring and audits – we can measure network adequacy exactly the way regulators do. Finding the same gaps they would find.

PROVIDER DATA ACCURACY

We know that provider data is dynamic, and you need a partner who can help you verify and perform regular checks on its accuracy. With Quest Analytics®, we verify your data against trusted industry sources like the National Plan and Provider Enumeration System (NPPES) and Office of the Inspector General (OIG) along with our BetterDoctor® Exchange to measure directory accuracy where others can’t. We help you PROMOTE data we’ve verified to be accurate, DEMOTE data that is unverified, and when we find data that needs fixing, we help you FIX it and NOTE what has changed.

“Instead of having to build the database to know who to go after, all the time is spent going after the providers that we need to get to network adequacy. So it’s streamlined the process.  I’ve saved a ton of money.”

— VP of Provider Networks, Northeast Regional Health Plan

WORKFLOW EFFICIENCY ACROSS ALL LINES OF BUSINESS

From the beginning, the Quest Analytics® platform was created to break down the silos that undermine efficiency in your organization. Our tools can be used across all departments, providing actionable insights about your provider network that unites network management, compliance, enrollment, sales, recruiting and credentialing teams.

Quest Enterprise Services lets you share data and resources across product lines, eliminating duplicate effort and dramatically increases efficiency. We provide the tools you need to measure, manage and monitor performance, helping you reduce regulatory risks, build better networks and deliver better member experiences.

And QES provides you with efficiencies and growth opportunities across the enterprise with an ROI you can count on.

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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.

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