For Payers & Plans

Medicaid

Measure Variances in Adequacy and Accuracy Together—Simultaneously

Quest Analytics offers the first and only network management platform designed to measure variances in adequacy and accuracy together—simultaneously—at the network and directory levels, where you get audited.

Turbo-Charged Data Insights

Quest Analytics offers the first and only network management platform designed to measure variances in adequacy and accuracy together—simultaneously—at the network and directory levels, where you get audited.

Measure Adequacy

Quest Enterprise Services measures network adequacy exactly the way regulators do—because CMS and many states use our tools in their audits, it finds the same gaps they would find.

Measure Accuracy

Directory accuracy is measured by leveraging our National Database of primary-sourced, continuously updated provider data, along with other industry-known sources of truth. Letting you know what’s right, wrong and missing from your provider data allows you to focus resources and prioritize efforts on remediating the inaccuracies with the most impact.

Manage & Monitor Together

And when you can measure these key performance indicators, you can finally manage them, efficiently, using powerful new tools to close adequacy gaps and correct provider directory accuracy issues. You can monitor performance over time to guide your management efforts.

The result is not just compliant networks, accurate directories and better member experiences; it’s a stronger, smarter and more competitive organization overall.

Actionable Insights Across the Enterprise

Enterprise-wide management means more than connecting silos and streamlining the workflow.

It means giving everyone in your organization, regardless of product line or job function, access to the tools and insights they need to work more intelligently and more proactively.

And it means for the first time being able to ask—and answer—fundamental questions that will transform the way you work.

Adequacy + Accuracy In One Platform

We measure adequacy and accuracy the way regulators do – because the Centers for Medicare and Medicaid Services and State Regulators use our tools too. We have pre-built Medicaid templates for many states based on the publicly available released standards. We monitor each state for updated guidance and make changes accordingly.

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Three Key areas where Quest Enterprise Services can create and enhance your Medicaid Network value, include:

1- Adequacy Compliance Monitoring and Audit Readiness Services

Measure and monitor your network adequacy score in real-time shared across your organization. 

2- Expansion Opportunities

QES provides you with several tools to help make strategic service area determinations with minimum effort. You can view the opportunity analysis of your current network in potential expansion areas, thereby allowing you to target areas that have the greatest return for the least amount of effort, including:

  • Number of Gaps/regulatory compliance
  • Total beneficiaries in the geographic area
  • Potential annual value based on Star Ratings
  • Market penetration (reflected as a percentage of beneficiaries enrolled in another plan)
3- State-by-State RFPs

QES helps you respond to RFPs state-by-state more effectively by enabling you to:

  • Build targeted networks in a fraction of the time using our smart recruiting tools
  • Identify quickly the best expansion opportunities based on revenue potential and recruitment lift to fill gaps
  • Monitor and trend the progress and performance of each expansion opportunity providing full transparency across your organization
  • Monitor and trend the progress and performance of each expansion opportunity providing full transparency for management

In addition, QES for Medicaid

Services include:

Provider Data Management Services

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

Accuracy Services

Measure and monitor your network accuracy score, identify what’s right, wrong and missing within your data, and remediate the inaccuracies at a provider level.

Impact Analysis Services

Fill your gaps more efficiently with a lens into which 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.

Termination and Volume Termination Analysis

Create value-based or tiered networks with better modeling while improving your strategic understanding of how current and future provider contracts impact your network adequacy.

Custom Client Fields

Assess building a high-quality network that continues to meet network adequacy utilizing metrics on network/ prospect providers that you want, such as quality, utilization fields or cost & efficiency data.

NPI Certification Date

CMS encourages providers to verify their information in NPPES, and has stated that health plans will receive safe harbor if their directory data matches the information in NPPES. We display this verification date within the QES adequacy analysis.

Client Services Support

Receive access to a dedicated Quest Analytics Consultant.

A Legendary Enterprise Solution

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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See Our Available Templates

Quest Analytics has pre-built templates based on the standards & requirements for Medicare Advantage, Medicaid-Medicare, and an ever-growing list of state Medicaid programs. See which templates are available for you today! 

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