Success Stories in Provider Network Management

SC DHHS Modernizes Medicaid Network Oversight

How Enhanced Data Insights Helped a Health Plan Improve Healthcare Access

Meeting Medicaid Network Adequacy With Advanced Network Management Solutions

This MCO faced unique challenges in efficiently assessing and ensuring network adequacy and provider data accuracy for its Medicaid program.

How QES® Access Reporting Modernized a National Payer’s RFP Process

The Sales team at a Top 10 National Payer needed to stand out from their competitors when responding to Employer Group Benefits RFPs. To do so, quickly generating network access reports was critical for strong RFP responses.

QES® Helps a National Health System Take the Offensive in Payer Negotiations

Their team was looking for automated and integrated tools and insights that would allow them to better communicate the value of their Integrated Delivery Network, by specialty, with an end goal of improving their position during contract negotiations.

How HealthNow Transformed Network Efficiency and ROI with QES®

A costly CMS penalty proved they couldn’t keep managing their provider networks the same old way. For a New York health plan, smarter provider network management was a better investment than they imagined.

Accelerating Territory Expansion in Three Months with Quest Enterprise Services®

Learn how this health plan accelerated its expansion into new counties and states.

How QES® Transformed Medicare and Medicaid Network Building

Having struggled to build a Medicaid network, they now faced the more complex requirements of Medicare — with only one shot to get it right.

Oversight, Meet Insight: Automating Network Visibility with QES®

They had manual oversight of provider network adequacy—but zero insight into provider availability, provider data accuracy or performance across health plans.

National Vision Care Administrator Enhances Provider Network Data and Expands Health Plans

Discover how a National Vision Care Administration achieved a 15+ Health Plan Expansion and a reliable provider data accuracy process with Quest Analytics®.

Removing Compliance Guesswork: A Healthcare Network Adequacy Case Study

They had no effective way to find their own adequacy gaps — but CMS and state regulators were finding plenty.

Achieving Enterprise-Wide Compliance Across Medicare and Medicaid Networks

Struggling to meet the diverse adequacy requirements of CMS and states, the plan needed a smarter way to work.

How Quest Analytics Helped a Health System Build Their Own CMS-Compliant HMO

Wanting to set up their own HMO, they needed to build a county-wide Medicare Advantage network — with no previous experience managing CMS network adequacy requirements.

TAKE THE FIRST STEP FROM ADEQUATE TO EXCELLENT

We partner with 95 percent of America’s health plans and have experienced the challenges of provider network design, optimization and management. We’ve built our platform by working side-by-side with you and working closely with CMS and more than 30 state regulatory agencies, independent review organizations and brokers. We know what the regulators are looking for and what tools your organization needs to build differentiated and excellent provider networks and member experiences. Contact us today and book a strategy session.