Payers & Plans

Proven Provider Network Management for QHP Certification


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.


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.


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:


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, need to take a deep dive into provider information, or want 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!


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!

Provider Network Management Resources

How Provider Claims Insights Can Improve Your Provider Network Management
As an insurance provider, your primary goal is to connect your members with reliable and available healthcare services. So, it’s frustrating when you try to do so but end up...
The Growing Need for Accurate Provider Data
Gather around healthcare enthusiasts! The focus on accurate provider data is heating up and we have the inside scoop. From federal and state regulations to health policymakers, the buzz is...
Keeping Ghost Networks Out of the Game in California
Trust and accuracy are paramount in health insurance. Just like Charlie Brown’s cautionary tale with Lucy and the football, healthcare consumers in California have experienced disappointment and frustration when trying...
Top Trends For Provider Data Management
Summer is almost here, and we don’t want you to spend it working long hours behind your computer. That’s exactly why we’re sharing the latest Provider Data Management trends that...
Four Ways Regulators Prioritize Health Equity into Network Adequacy
In the pursuit of high-quality healthcare, it is essential to go beyond network adequacy metrics and prioritize health equity. In a conversation between Scott Westover, SVP of Network and Regulatory...
Provider Network Management Insights: Current Market Trends
Health plans nationwide are shaking things up. They are reevaluating their approach to provider network management. With evolving goals and strategies, these plans are continuously adjusting and expanding to meet...
Quest Enterprise Services Accuracy: Areas of Future Innovation
Who doesn’t love a sneak peek? We can’t wait to show you what’s next for Quest Enterprise Services Accuracy. Here are four innovative areas you can expect from us.  Innovation...
Quest Enterprise Services Adequacy: Driving Provider Network Efficiency with Future Innovations
Take a leap into the world of Quest Enterprise Services Adequacy and discover the future of provider network management. We’re thrilled to unveil what we have in store for you....
Unverified Provider Data: The Hidden Costs and How to Solve Them
You’re probably aware of all the buzz surrounding provider data accuracy. And as someone who takes their job seriously, you probably think about this all the time. You might even...


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.

Schedule Now