QuestAnalytics CaseStudy ExceptionsPackage.pdf
WHO WE HELPED
Health Plan that offers Medicare
Advantage and Medicaid Plans
HOW WE HELPED
® ®
Quest Enterprise Services (QES)
Exceptions Package
The Client was having trouble meeting
network adequacy requirements in certain
counties, and every year this happened,
they had to file exception requests.
The problem was two-fold: it wasn’t just inconvenient — it
was time-consuming and costly. It required hours of work
by multiple departments within the company. It also created
delays in growing their business.
The Client needed a better way to understand the market
and expedite their exception process. They found it with
the QES Exceptions Package.
USING THE QES EXCEPTIONS PACKAGE, THIS CLIENT
ELIMINATED ALL 17 EXCEPTION REQUESTS
EXPEDITING THE PROCESS.
ENHANCING THE EXCEPTION NARRATIVE.
OR BETTER YET, ELIMINATING THE NEED FOR AN EXCEPTION REQUEST.
The QES Exceptions Package gives this Health Plan actionable insights into provider and market data, the ability to automate multiple manual tasks, and streamlined workflows — all while increasing efficiency and reducing costs.
Now they have one central location for multiple teams to track and manage the exception process year-round — making it much easier for everyone involved. The QES Exceptions Package also decreased time spent on manual tasks allowing them more time to focus on growing their business.
QES EXCEPTIONS PACKAGE
| ELIMINATE OR REDUCE | INCREASE EFFICIENCY | REDUCE RESOURCES |
|---|---|---|
| EXCEPTION REQUESTS | ACROSS ALL DEPARTMENTS | Decrease the number |
| Identify providers in the | Allow Contacting, Network | of hours and resources |
| market to contract with to | Management, and other teams | spent on research needed |
| fill gaps easily. | quickly find the information they need to complete the | to create the exception narratives for regulators. |
| exception request. |
| PROMOTE COLLABORATION | STREAMLINE | ENHANCE MARKET | |
|---|---|---|---|
| Review all specialty exceptions | EXCEPTION NARRATIVES | ADEQUACY COMPARISONS | |
| that have been entered and | Leverage the market analysis | Measure and monitor their | |
| allow access for multiple | to understand whether gaps | provider networks against the | |
| personnel to track the status | are due to a network or a | current market providers to | |
| of each exception on one platform. Making it easy to | market issue. | determine network breadth and exception eligibility. |
identify providers who need to be on exception justifications and track recruitment efforts throughout the year.
To request more information, visit: questanalytics.com
STREAMLINE, SIMPLIFY AND STRENGTHEN YOUR
EXCEPTIONS PROCESS WITH QUEST ANALYTICS ®
The QES Exceptions Package automates and simplifies your network
adequacy exception request process for the Centers for Medicare & Medicaid
Services (CMS) and State submissions, leaving you with more time to focus on
other priorities.
With the advanced features in this package, you’ll be able to quickly
gather provider, membership and market insights to create a more
complete and thorough explanation for your network adequacy exception
requests. In some cases, you could potentially remove the need for a
network adequacy exception request altogether.
You’ll also be able to easily communicate key information about your
providers and network adequacy exceptions all in one place. Now
your team has a one-stop shop, accessible 365-24-7, for monitoring
network progress, reviewing data and making key strategic decisions.
Schedule a complimentary consultation today to see how QES can work for you.