Quest Enterprise Services WHO’S AFRAID OF A NETWORK AUDIT

Not you. You’ve found

Quest Analytics.

WE UNDERSTAND THE CHALLENGES OF PROVIDER NETWORK MANAGEMENT

And we have the solution. QUEST ENTERPRISE SERVICES

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

MEASURE
Both network adequacy
& directory accuracy

MANAGE
With smart tools
& actionable insights

MONITOR
Performance & drive
improvement

From the Leader in Provider
Network Management

TRUSTED BY
400+
HEALTH PLANS

TRUSTED BY
CMS &
STATE REGULATORS

TRUSTED BY
BENEFIT
CONSULTANTS
& BROKERS

CONSULTANTS MEASURE MANAGE MONITOR

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.

This is your network under new management. This is Quest Enterprise Services.

ADEQUACY + ACCURACY IN ONE PLATFORM

We measure adequacy and accuracy the
way regulators do – because the Centers
for Medicare & 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

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

Compliance Monitoring

Impact Analysis Services

Termination Analysis

Custom Client Fields

Membership Analysis

NPI Certification Date

Client Services Support

COMMERCIAL SERVICES

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.

Competitive Advantage RFPs

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:

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 Commercial
Services, you’ll have the ability to view how you rank against
your peers.

Adequacy Services

Impact Analysis Services

Termination Analysis

Termination Analysis Network Performance Trending

Membership Analysis

Provider Data Management Services

Custom Client Fields

NPI Certification Date

Client Services Support

This is your network under new management.