For Payers & Plans

Medicare

Proven Provider Network Management

We Understand The Challenges Of Provider Network Management

And we have the solution.

Quest Enterprise Services (QES)

A powerful self-service SaaS platform that works across your organization to bring new intelligence and control to your provider network management.

Quest Enterprise Services

Smarter management for today’s provider networks.

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 use our tools too. We use the same standards and specialties to measure compliance as CMS and we update them annually in accordance with their release.

“Inaccurate provider directories … bring into question the adequacy and validity of the Medicare Advantage Organization’s provider network.”

—CMS 2020 Announcement
Our Services Across Business Lines Include:

Medicare Advantage

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.

Opportunity Analysis

Identify where you may be able to expand into other counties with minimum effort and the greatest potential return on your investment.

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.

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.

Client Services Support

Receive access to a dedicated Quest Analytics Consultant.

Adequacy Compliance Monitoring Services

Measure and monitor your network adequacy score in realtime shared across your organization.

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.

Medicaid Services

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.

  • Provider Data Management Services
  • Adequacy Compliance Monitoring Services
  • Impact Analysis Services
  • Termination Analysis
  • Membership Analysis
  • Custom Client Fields
  • NPI Certification Date
  • Client Services Support

Commercial Services

You’re able to measure, monitor and manage more than 80 specialties, including pediatrics, dental, vision, hearing, behavioral health and additional ancillary services. To help you ensure your members have adequate access to care, our commercial services include:

Competitive Advantage RFPs

Provide brokers and consultants a real-time view into your commercial product adequacy and provider data accuracy on an ongoing basis.

Network Performance Trending

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

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. More importantly, as the nation’s leading health plans incorporate Quest Analytics commercial services, you’ll have the ability to view how you rank against your peers.

  • Adequacy Services
  • Impact Analysis Services
  • Termination Analysis
  • Membership Analysis
  • Provider Data Management Services
  • Custom Client Fields
  • NPI Certification Date
  • Client Services Support

This is your network under new management.

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