Quest Analytics Expands Network Adequacy to Give States an Automated Review Process

APPLETON, Wis., Feb. 26, 2014 /PRNewswire/ -- Quest Analytics, leaders in delivering network adequacy solutions to the healthcare market, has expanded their industry leading desktop solutions to support an automated network adequacy solution for state and federal reporting requirements. This integrated solution provides both States and Federal Agencies the ability to qualify and monitor plans for network adequacy and ongoing compliance with the current and future standards. 

Pursuant to 45 C.F.R. 156.230(a)(2), an issuer of a QHP that has a provider network must maintain a network that is sufficient in number and types of providers, including providers that specialize in mental health and substance abuse disorder services, to assure that all services will be accessible to enrollees without unreasonable delay. All issuers applying for QHP certification will need to attest that they meet this standard as part of the certification/recertification process. 

For the 2015 benefit year, issuers will be required to submit a provider list that includes all in-network providers and facilities for all plans for which a QHP certification application is submitted. Unlike the certification process for benefit year 2014, CMS will no longer utilize issuer accreditation status, identify states with review processes at least as stringent as those identified in 45 C.F.R. 156.230(a), or collect network access plans as part of its evaluation of plans' network adequacy. Rather, CMS will review the collected provider list to evaluate provider networks using a "reasonable access" review standard, and will identify networks that fail to provide access without unreasonable delay as required by 45 C.F.R. 156.230(a)(2).  In order to determine whether an issuer meets the "reasonable access" standard, CMS will focus most closely on those areas which have historically raised network adequacy concerns.¹

Quest Analytics has been supporting this same reporting process for Medicare Advantage plan qualification.  "By evolving the Quest Analytics Suite™ we have expanded the technology with more flexibility to adapt to any federal or state based network adequacy reporting requirements", says John P. Weis, Co-founder of Quest Analytics.  Further John adds, "Why would you work with older tools that were designed for one purpose, when you can utilize the Quest Analytics Suite™ to meet multiple needs?" The Quest Analytics Suite™ solution allows network adequacy requirements to be managed through a self-service environment. It introduces efficiency and agility to the old self-reporting models, thus, meeting new proposed requirements for the Health Insurance Marketplace. The Quest Analytics Suite™ can eliminate much of the heavy lifting of network adequacy validation, and it empowers regulators with the information needed to qualify plans.  The process is simple, yet extremely powerful and can either be hosted internally or externally depending on resource requirements. 

David H. Hill and John P. Weis founded Quest Analytics in 2003.  Quest Analytics is an independent solutions company, built without ties to any health plan. Both Hill and Weis have extensive experience in commercial software development and consulting services for the healthcare industry. Their experience in the industry has brought many innovative solutions to the market ranging from; pioneering access analysis and disruption analysis tools, to evolving network adequacy solutions and right-sized network design services. Today, Quest Analytics' dedication to provide innovative solutions to challenges facing the healthcare industry continues, as their industry expertise is sought on a national basis. For more information, please contact us at 920.739.4552 or visit us at www.QuestAnalytics.com.

¹ http://www.cms.gov/CCIIO/Resources/Regulations-and-Guidance/Downloads/draft-issuer-letter-2-4-2014.pdf

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Phone: 920.739.4552

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