For Payers & Plans
Take Charge Of Your Provider Network Management Challenges
YOUR PARTNER WITH UNRIVALED EXPERIENCE
As a partner to 90% of America’s health plans, as well as benefit brokers, third-party administrators (TPAs), health systems, Integrated Delivery Networks (IDNs), and the emerging Health System organizations, Quest Analytics has experienced the challenges of provider network design, optimization and management. We’ve built our platform by working side-by-side with you because your challenges are ours to solve. And, because Quest Analytics works closely with The Centers for Medicare and Medicaid Services (CMS) and more than 30 state regulatory departments and independent review organizations, we know what the regulators are looking for and can help take the guesswork out of submissions and audit preparations.
MAINTAINING REGULATORY COMPLIANCE
Quest Enterprise Services. 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.
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.
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.
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.