Quest Analytics Introduces New Features to Improve Compliance with Federal Regulations

Quest Analytics, the leader in provider network management solutions and services, introduced three new features for Quest Enterprise Services (QES) designed to improve their client’s ability to address the No Surprises Act (NSA) and the evolving provider network regulations. The new offerings include:

• Accuracy API & Daily Refresh: With the No Surprises Act mandate that employer-sponsored, Marketplace and individual plans need to update their provider directories within two business days of receiving a provider notification that information has changed, the new Daily Refresh & API add-on option for QES Accuracy ensures that clients receive timely updates for their network providers daily, instead of weekly.
• Volume Targeting: Building on the workflow efficiencies created by Volume Terminations last year in QES Adequacy, Quest Analytics introduces Volume Targeting, allowing clients to quickly and efficiently evaluate the impact that adding a health system or large provider group would have on network adequacy requirements across lines of business.
• CCIIO QHP Template: The CCIIO Qualified Health Plans (QHP) Template in QES is pre-built based on the new PY 2023 CCIIO federally facilitated exchanges (FFEs) QHP Network Adequacy requirements and enables health plans to monitor provider network compliance easily, identify deficiencies in provider networks and streamline provider recruitment.

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“At Quest Analytics, we have a legacy of innovation and are proud of the work we do to ensure that our clients meet the complex and rapidly evolving state and federal regulations,” said Linda Borths, Chief Client Officer, Quest Analytics. “These new enhancements address the need to continuously monitor the accuracy of provider network data and the impact on network adequacy, as well as offer more efficient ways to measure and model networks while ensuring compliance.”

As part of Quest Analytics’ commitment to educating health plans on these regulations, Quest Analytics will host a webinar with AHIP entitled, “Understanding the network adequacy changes in the Medicare Advantage final rule,” on August 9. Quest Analytics’ Scott Westover, SVP Network and Regulatory Strategy, will be joined by Michael Adelberg, Principal – Healthcare Providers & Plans Practice Lead at Faegre Drinker Consulting, to discuss the proposed requirements of the CMS Final Rule for CY 2023, provide strategies for meeting the regulation, and discuss the influence this rule could have on future oversight.

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