Regulators
Take Charge of your provider network oversight challenges
Shaping the Future Healthcare
As a health plan regulator, you’re tasked with ensuring consumers can access high-quality, affordable healthcare services. What’s more, you need to be able to demonstrate sound policy and fiduciary oversight of health plans. That’s a lot to keep up with. And we’re here to help.
We’ve worked closely with the Centers for Medicare & Medicaid Services (CMS) for nearly 15 years to improve the quality of Medicare Advantage and Qualified Health Plan (QHP) networks nationwide. We’re a trusted resource for more than 30 state regulatory departments and independent review organizations across multiple lines of business, including the largest Departments of Insurance and Departments of Health and Human Services in the nation.
We continually collaborate with federal policymakers, State Insurance Commissioners and State Medicaid Directors, helping them develop strong oversight of health plans as well as helping to create new measures for health equity and telehealth, all to ensure the best access to care among the populations they serve.
Simplify Provider Network Monitoring Processes
Streamline regulatory oversight with Quest Enterprise Services™ (QES™), giving you the ability to conduct an instantaneous comparison of performance across multiple plans. QES provides a comprehensive view not just of the provider availability within specific geographies, but also of the relative network adequacy of competing plans within your market. This dual-layered insight gives you a deeper understanding of the available provider landscape. Equipped with this critical information, you are positioned to enhance your regulatory oversight and adapt requirements as the landscape evolves.
Solutions for All Lines of Business
Since our founding more than 20 years ago, we’ve been partnering with regulatory agencies to offer unparalleled expertise in provider network design, management, and compliance across all lines of business. Our solutions are the cornerstone for CMS, the Center for Consumer Information and Insurance Oversight (CCIIO), multiple state insurance and Medicaid departments, providing reliable network oversight and monitoring capabilities.
Strengthen Oversight and Promote Compliance
Provide guidance to help provider networks stay ahead of the curve by automating your provider network review process, viewing timely provider data, and comparing plan performance to help ensure health plans demonstrate compliance with your critical network adequacy standards.
Enhance Consumer Protection and Experience
Monitor participating health plan network adequacy and provider data accuracy within your jurisdiction, ensuring that your constituents can easily find and access the right provider to meet their healthcare needs.
Solutions for All Lines of Business
Since our founding more than 20 years ago, we’ve been partnering with regulatory agencies to offer unparalleled expertise in provider network design, management, and compliance across all lines of business. Our solutions are the cornerstone for CMS, the Center for Consumer Information and Insurance Oversight (CCIIO), multiple state insurance and Medicaid departments, providing reliable network oversight and monitoring capabilities.
Quest Analytics has a long-tenured partnership with CMS providing the necessary tools and solutions essential for thorough network oversight and the evaluation of network adequacy for Medicare Advantage Part C & D and Medicare-Medicaid Plans (MMPs).
As CMS conducts annual network adequacy reviews of health plans under their purview, including MMPs, and triennial reviews of participating health plans to verify the accuracy of submitted network information, they rely on QES to help process annual submissions of HSD tables from participating plans to ensure compliance.
Additionally, we work with CMS and regulators to help determine feasible regulations based on geography and available providers by specialty — helping to eliminate unnecessary exception fillings that take up scare resources.
Our partnership with CMS underscores the power and significance of our relationship in the provider network compliance and management industry, setting a standard for ensuring compliance and enhancing the quality of care for the population served.
Quest Analytics partners with dozens of State Medicaid Agencies to help develop quantitative network adequacy standards that are compliant with federal standards. Given Quest Analytics’ knowledge of evidence-based quantitative network adequacy standards, our strong relationships with network adequacy leaders inside CMS, and our contractual relationships with Managed Care Organizations, Quest Analytics is in a strong position to offer expert assistance to any State in the development of standards.
Federally-facilitated Marketplace
Quest Analytics partners with CCIIO to deliver targeted solutions and services that assess network adequacy for Qualified Health Plan (QHP) certification. This is vital as 29 states participate in the Federally-facilitated Marketplace and must comply with network adequacy requirements. Our offerings enhance the agency’s ability to monitor compliance effectively while simultaneously deepening its insight into market trends and behaviors.
State-based Exchanges
Quest Analytics partners with policymakers and regulators on State-Based Exchanges, offering solutions and services to assess network adequacy for Qualified Health Plan (QHP) certification. Our expertise streamlines the transition to align state network adequacy requirements with Federal standards, while enabling a thorough understanding of the optimal requirements for the state. Agencies can enhance their compliance monitoring capabilities and gain deeper insights into market trends and behaviors.
Solutions for Regulators
With Quest Enterprise Services™, your agency has the actionable insights, resources, and tools needed to help manage and monitor provider networks.
Enhance your ability to evaluate and monitor health plan network adequacy. Additional insights into market dynamics and geographic barriers help you implement community-appropriate standards and enforce regulations to protect consumers.
Leverage a continuously updated database of provider information as a reference file against your beneficiary information, ensuring data integrity in network adequacy, access, and performance as part of your health plan oversight efforts.
Incorporate additional provider data insights, including national claims data, to assess claims activity, provider performance, payer mix, and efficiency scores, helping you evaluate clinical activity by specialty and location.
Simplify what-if scenarios with three powerful tools: Volume Termination, Volume Targeting, and Volume Reporting. Gain quick insight into the effects of provider changes across plans, counties, and networks.
Discover More
Dive into additional resources for more information and valuable insights.
Join Our Regulator Exclusive Webinars
Connect with fellow regulators and policymakers in our regulator exclusive webinars, designed to address critical issues such as network adequacy and provider data accuracy. Learn about advanced strategies, share valuable insights, and collaborate to drive meaningful changes in the healthcare industry.
For more information, please contact our Regulatory Team at Regulatory@questanalytics.com.
Supporting Your Efforts in Delivering Quality Healthcare
As you work to ensure that health plans in your state offer affordable and quality healthcare, Quest Analytics is here to assist you. Contact us with any questions or to discuss how we can support your efforts.
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