Proven Provider Network Management for Qualified Health Plan Certification

Save Time, Stay Compliant

As the healthcare landscape continues to change, you may find that you’re being asked to have more provider data, and you need it fast. Then, there are the new compliance requirements to keep up with, including knowing which network will be regulated by CMS and which network will be regulated by the state. Oh, and don’t forget about making sure the provider file that you’re using to analyze the network has been properly updated and that you send the report by end of the day Friday.  All in all, it’s enough to make your head spin.

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

Compliance Confident

At Quest Analytics we understand how important it is to stay on top of your regulatory requirements. That’s why we deliver peace of mind by showing you what regulators will see when they evaluate your network. We streamline your compliance monitoring for network adequacy and provider data accuracy so that you can identify deficiencies in your provider network and understand what is right, wrong and missing in your provider data.

Meet Compliance for QHP Certification

Our CCIIO QHP Network Adequacy template is built according to the federal requirements for specialty type, time and distance standards set forth by CMS. Not only will the template save you time, but it will also allow you to:

  • Continuously monitor your network to ensure network adequacy compliance
  • Quickly identify deficiencies in your provider network
  • Easily understand what is right, wrong, and missing in your provider data
  • Streamline you provider recruitment efforts

Comply with the No Surprises Act

With Quest Enterprise Services, you gain the tools you need to establish a provider data verification process that’s right for your business. Whether you’re looking for a quick snapshot of the latest changes in your data, needing to take a deep dive into provider information or wanting an easier way to make strategic decisions about your network, we have you covered.

And our clients benefit from our team partnership. We do the heavy lifting of data management, outreach and analysis so that you can spend your time focusing on what really matters: making sure your provider directory is ready for prime time!

QHP Marketplace Resources

Stay up-to-date on the latest network adequacy requirements and best practices for Qualified Health Plans (QHPs). Explore our growing library of blogs, briefs, videos and more!

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