What’s New in QES Adequacy: A Look at the Latest Features

We’re building on the Quest Enterprise Services® (QES®) Adequacy foundation you know and trust by introducing more features that make provider network analysis smarter and more efficient. Ready to see what’s new? Let’s dive in!

New Features & Enhancements in QES Adequacy

Network Adequacy Templates

As federal and state network adequacy standards continue to evolve, our industry-leading templates evolve right along with them. These ready-made tools are designed to streamline your compliance evaluations, making the process easier and more efficient.

Choose from templates tailored for Medicare Advantage, Medicare-Medicaid, the Federal Exchange Marketplace, State-based Exchanges, and Medicaid—and the list keeps growing! Each template is built to align with current adequacy standards and includes distance calculation options like Straight-Line, Estimated, and Geographic Distance.

With these simple, adaptable templates, you can confidently keep up with new requirements while staying focused on maintaining a strong and compliant provider network.

Network Analysis at Zip Code and Zip Code Classification Levels

Every organization has unique needs for network analysis, and we’re here to meet them. QES Adequacy now allows you to analyze provider networks at the Zip Code or Zip Code Classification level.

These new options complement the existing county-level analysis and offer opportunities to:

• Evaluate networks at the geographic levels required by your plan programs or business needs, ensuring enrollees have reliable coverage.
• Identify provider specialties, zip classifications, and geographic areas that meet—or fall short of—your requirements.
• Access flexible reporting options to extract, evaluate, and interpret data insights tailored to your goals and workflows.
• Pinpoint providers servicing each zip code and specialty, while identifying non-contracted providers who can help close network coverage gaps.

Adding zip code-based analysis creates opportunities for more teams across your organization to leverage QES Adequacy effectively.

QES Exceptions Package

Handling network adequacy exceptions can be time-consuming and tedious. The new features in QES Exceptions Package simplify the process from start to finish, letting you oversee everything from one centralized view.

QES Exception Document Generator

Automate the creation of CMS exception requests. Inputs are translated into finalized documentation ready for submission, saving significant time.

QES Pattern of Care Providers

Include providers outside existing network adequacy standards directly in your analysis to build stronger supporting documentation for CMS and state submissions.

Streamlined Solutions, Smarter Decisions

There you have it. We’ve lined up innovative solutions that will make your provider network management experience easier, more insightful, and more efficient. Stay tuned for more updates as we continue to roll out solutions to tackle provider network management challenges!