#### PROVIDER DATA ACCURACY & NETWORK ADEQUACY

### BETWEEN ADEQUACY AND ACCURACY

#### HOW PROVIDER DATA ACCURACY IMPACTS NETWORK ADEQUACY

##### UNDERSTANDING THE CONNECTIONS

Maintaining a provider network can be a challenging balancing act for health plans. Network adequacy and provider data accuracy are two key components of a successful provider network, and yet they are often dealt with independently. As health plans work to correct provider information, they must also consider the impact that will have on network adequacy. **Let’s take a closer look at an example of how this can happen.**

#### EXAMPLE: HEALTH PLAN A

##### In County X, Health Plan A has 9 Servicing Providers for Plastic Surgery.

##### At first glance, it appears they have network adequacy covered.

##### Dr. Miller  Dr. Suarez  Dr. Armstrong  Dr. Singh

##### Plastic Surgery  Plastic Surgery  Plastic Surgery  Plastic Surgery

##### Dr. Cooper  Dr. Collins  Dr. Liu  Dr. Langston  Dr. Flynn

##### Plastic Surgery  Plastic Surgery  Plastic Surgery  Plastic Surgery  Plastic Surgery

**After taking a closer look at the providers, it is revealed that only 1 provider has attested** **to the required information.** Health Plan A must remove the other 8 providers to comply with provider directory accuracy regulations. This left them with only Dr. Collins — who alone does not allow the health plan to meet the network adequacy requirements for the county. **The result? Health Plan A now has a specialty gap they need to fill.**

##### Dr. Miller  Dr. Suarez  Dr. Armstrong  Dr. Singh

##### Plastic Surgery  Plastic Surgery  Plastic Surgery  Plastic Surgery

**Attestation Age:  Attestation Age:  Attestation Age:  Attestation Age:** **Not Attested  Not Attested  Not Attested  Not Attested** **Serves:  Serves:  Serves:  Serves:**

**98.7%  98.7%  96.4%  100%**
##### Dr. Cooper  Dr. Collins  Dr. Liu  Dr. Langston  Dr. Flynn

##### Plastic Surgery  Plastic Surgery  Plastic Surgery  Plastic Surgery  Plastic Surgery

**Attestation Age:  Attestation Age:  Attestation Age:  Attestation Age:  Attestation Age:** **Not Attested  81 Days  Not Attested  Not Attested  Not Attested** **Serves:  Serves:  Serves:  Serves:  Serves:**

**0.9%  70.4%  100%  100%  100%**
**ONLY ONE PROVIDER** Dr. Collins has attested to the required only services information **in the past 90 days. 70.5% OF** **New Gap** **ELIGIBLES.**

##### Doesn’t meet network adequacy requirements.

#### HAVING THE RIGHT RESOURCES CAN IMPROVE YOUR NETWORK ADEQUACY AND ACCURACY

To tackle the challenges posed by network adequacy and provider data accuracy requirements, health plans need a **comprehensive solution and approach that can ingest data from multiple sources across various input** **channels and perform regular outreach to providers.** Quest Analytics can help health plans with this challenge, providing a comprehensive solution to ensure network adequacy and data accuracy compliance.

##### Multi-Channel Analysis &

##### Network Outreach Inspection Actionable

**Data** Rolling Outreach Multi-Source **Insights** **Ingestion** at 90 days Verification QES Core

##### Aggregation & Provider Confidence

##### Consolidation Attestation Scoring

One To Many Individual & Group Machine Learning

##### <u>Uniquely Quest Analytics</u>

**Consulting**

# SAVE TIME, STAY COMPLIANT

**™**

## WITH QUEST ANALYTIC S

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.**

##### Contact us today to see how we can help improve your provider data accuracy.