Payers and Health Plans

Empowering Healthcare Payers with Advanced Provider Network Management

Discover why more than 400 health plans partner with Quest Analytics®.

Your Strategic Partner in Provider Network Management

Today, creating access to care for your members is no longer accomplished by regulatory compliance alone. It’s about delivering high-quality, differentiated, and competitive networks that also address the unique needs and health equity considerations of your members. Quest Enterprise Services® (QES®), our self-service SaaS-based provider network management and decisioning platform, gives you a competitive edge by allowing you to measure, manage, monitor, and model your provider network adequacy, performance, and provider data accuracy across your entire organization and all lines of business. It does all that in a single solution—something no one else can offer.

Maintaining Regulatory Compliance

Benefit from Quest Analytics’ trusted relationship with CMS and state authorities to provide your health plan with tools, approved templates, and data to help you meet and exceed regulatory compliance requirements.

Provider Directory Data Accuracy

Enhance provider data accuracy with regular checks against trusted sources like NPPES, OIG, machine learning, and our BetterDoctor® Exchange. We help you promote verified data, demote unverified, fix inaccuracies, and note changes for quality assurance.

Workflow Efficiency Across all Lines of Business

Streamline your organization’s processes with tools and insights that help eliminate cross-departmental silos and unite your network management, performance, compliance across all lines of business — giving your team an efficiency boost, while improving your overall member experiences with measurable ROI.

Unique Data Analytics & Insights

Boost your strategic goals by harnessing unparalleled insights from our exclusive data. Our insights stem from our proprietary data – network files submitted by payers and then validated by regulators, reflecting a true state of the network. By enriching this data with BetterDoctor® attestations, affiliations, and claims information, we unlock unique insights into network adequacy and performance, helping you understand the competitive landscape and build differentiated networks.

Supporting All Healthcare Lines of Businesses

Quest Analytics extends its expertise across the spectrum of business lines, ensuring comprehensive network management and compliance support. Our solutions are designed to help with:

Commercial

We are your partner in optimizing provider networks for commercial health insurance plans. We understand the vital role that a strong network plays in delivering quality healthcare to insured populations. That is why we have developed tools within QES designed specifically for you: the forward-thinking commercial insurance market professionals committed to staying ahead and delivering the best outcomes for your members. Our proven provider network management solutions empower you to take your network from adequate to competitive, ensuring that you can meet the needs of your insured population and stay ahead in this ever-evolving industry.

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Medicare Advantage Plans

Through our long-standing partnership with the Centers for Medicare and Medicaid (CMS), we empower Medicare Advantage plans with innovative, automated solutions and templates designed to streamline network management, elevate operational efficiency, and ensure compliance with CMS regulations. Our platform provides essential insights for teams focused on network optimization, provider recruitment, market growth, and Medicare Advantage network submissions. With multiple viewing options and quick data analysis capabilities, Medicare Advantage organizations enhance team collaboration and comply with regulatory requirements while strategically planning services area expansions and improving the member experience.

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Regulatory Resource Center

Medicaid Plans

We provide Medicaid Plans with innovative, data-driven network management solutions. Our platform uniquely measures network adequacy and provider data accuracy simultaneously, ensuring compliance and operational excellence. Say goodbye to interpreting each different state Medicaid template, all with different and unique requirements, and hello to time savings by leveraging our pre-built Medicaid templates. By leveraging our advanced tools, Medicaid plans can efficiently address gaps in provider networks and directories, leading to improved compliance, enhanced member experiences, and a competitive edge in the healthcare market.

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Regulatory Resource Center

QHP Marketplace Exchange Plans

We help streamline the complex world of Qualified Health Plans (QHP) with targeted solutions for health insurance issuers navigating provider network management, network adequacy compliance, provider data accuracy, and QHP certification. With our ready-made templates and custom solutions, issuers on the Federally-facilitated Exchange, the State-Based Exchanges and the State-based Exchanges on the Federal Platform (SBE-FPs), can easily monitor network adequacy compliance, support physician recruitment, evaluate network expansion, identify and remediate deficiencies, and maintain the highest standards of provider data accuracy.

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Regulatory Resource Center

Transforming Ancillary Healthcare with Quest Analytics

Quest Analytics simplifies healthcare management, offering solutions for Dental Plans, Vision Plans, Health Systems, and Behavioral Health. We address challenges National and Regional Payers face, from regulatory compliance to member experience enhancement. Our tools help balance quality and cost, align with market goals, and maintain competitive differentiation. Partner with us to navigate the healthcare landscape and redefine healthcare management.

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Optimizing Dental Plan Performance

Enhancing Vision Plan Efficiency

Streamlining Health System Operations

Advancing Behavioral Health Services

"Monitoring and maintaining network adequacy on a weekly basis has been incredibly beneficial for our organization."

— Director of Network Management, Regional Health Plan

"The ease of use and functionality of the tools provided make network adequacy tasks simple and straightforward."

— VP of Healthcare Services, National Health Plan

"Having the ability to calculate network sufficiency in-app has streamlined our processes immensely."

— Chief Operations Officer, Ancillary Plan

"Quest Analytics innovative solutions have transformed our approach to network adequacy, enhancing our productivity."

— Senior Product Manager, National Health Plan

"Identifying impactful targets has never been easier, thanks to the intuitive design of the tools."

— Network Development Specialist, Regional Health Plan

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Dive into additional resources for more information and valuable insights.

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Proven Provider Network Management

Provider Claims Insights

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Payers and Health Plans

Empowering Healthcare Payers with Advanced Provider Network Management

Your Strategic Partner in Provider Network Management

Maintaining Regulatory Compliance

Provider Directory Data Accuracy

Workflow Efficiency Across all Lines of Business

Unique Data Analytics & Insights

Supporting All Healthcare Lines of Businesses

Transforming Ancillary Healthcare with Quest Analytics

Optimizing Dental Plan Performance

Enhancing Vision Plan Efficiency

Streamlining Health System Operations

Advancing Behavioral Health Services

Discover More

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