For Payers & Plans

Commercial

Providing smarter management for today’s commercial networks.

The Leading Healthcare Network Management Partner

Quest Analytics helps America’s leading commercial plans measure, manage and monitor network performance

Our SaaS-based Quest Enterprise Services links network adequacy and provider directory accuracy for the first time in one platform across all business lines.

It’s time to take your network from adequate to competitive with smarter tools and actionable insights that drive performance, help win RFPs and help you respond to accreditation requests with confidence.

Give your commercial sales team a competitive edge with following network analytics:

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Market Analytics
  • Reduce out of network utilization by showing the average time and distance members have to travel for care
Sales Analytics
  • Show your network breadth based on specialties important to each client
  • Demonstrate the capacity of your network at the point of sale
  • Provide clients with an understanding of your appointment availability
  • Track your network’s performance overtime
Accuracy Analysis
  • Offer SLAs and leverage opportunities based on the demonstrated accuracy of your provider directory
  • Reduce surprise billing by promoting and prioritizing search results with providers who have verified their information

Conquer Compliance

Commercial network regulations vary by state and by how you define your commercial network. With an increasing focus on access to care in America, regulations around network adequacy and provider directory accuracy for individual and commercial plans are evolving.

With more pressure to eliminate surprise billing and mental health parity, give your plan a competitive advantage by managing the risk before it becomes a problem.

Measure both network adequacy and directory accuracy. Manage with smart tools and actionable insights. Monitor performance and drive improvement.

Managing Down Risk

Commercial network regulations vary by state and by how you define your commercial network. With an increasing focus on access to care in America, regulations around network adequacy and provider directory accuracy for individual and commercial plans are evolving.

With more pressure to eliminate surprise billing and mental health parity, give your plan a competitive advantage by managing the risk before it becomes a problem.
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Our Commercial Services Include:

1. Competitive Advantage

RFPs Provide brokers and consultants a real-time view into your commercial network’s adequacy and provider data accuracy on a ongoing basis.

2. Provider Data Management Services

Validate your provider network data, while tracking and trending your progress over time.

3. Market Comparisons

Have the ability to understand the depth of your network and your market share compared to the total availability of providers by specialty.

4. Membership Analysis

Model and assess your network using your own member data, in addition to the beneficiary file. Also, prioritize filling deficiencies based on the amount of membership at risk.

5. Network Performance Trending

Respond to accreditation agency requests, such as NCQA with confidence by demonstrating an ongoing process and providing a real-time view into network performance over time.

6. Adequacy Services

Measure, manage and monitor your network adequacy score in real-time, including the ability to understand how current and future provider contracts impact your network adequacy. Utilize additional metrics on network/prospect providers that you want, such as quality, utilization fields or cost & efficiency data.

7. Accuracy Services

Understand what’s right, wrong and missing within your provider data enabling you to remediate issues, manage any potential impact on your network adequacy and track performance over time.

8. Impact Analysis Services

Fill your gaps more efficiently. View what providers are available in the Market as well as within your other lines of business and their impact on your network adequacy by geography and specialty.

Adequacy + Accuracy In One Platform

By running all of your networks through a single provider network management platform, you’ll gain a better understanding of the strength of your network and the impact of your providers across business lines. You’ll create cross-departmental efficiencies, cut costs and have a realtime lens into how your network compares to the market.

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Solve Your Provider Directory Accuracy Challenges Today

Our team is ready to help you address the challenges provider data presents. We want to help you take your member experiences to the next level and avoid regulatory risks, like audits, and meet the mandates around surprise billing.

Contact us today to book a strategy session to understand and provide guidance to limit your exposure.

Book a Strategy Session