How provider data works

Does Candor Health measure network adequacy?

No. Network adequacy measurement and the filings that go to CMS and state regulators are what Quest Analytics does. Candor Health keeps the provider records underneath that analysis accurate, which decides whether the adequacy result is real.

The plain answer

Adequacy tools count the providers, and Candor Health makes sure the providers being counted are real

An adequacy report is only as good as the records it measures. That is where the two jobs connect.

  1. 01

    What is network adequacy measurement, and who does it?

    Network adequacy is whether a plan's network has enough providers of each type within the time and distance standards regulators set. Quest Analytics has measured and filed it for health plans since 2003. Quest says it works with 90% of payers and 30+ state regulators, and its QES platform covers network compliance, data integrity and performance. Quest also owns BetterDoctor, a provider attestation portal.

    Quest Analytics: QES
  2. 02

    What does Candor Health do?

    Candor Health builds each provider record from 120,000+ sources and 4 billion+ claims a month, scores every field and republishes daily. Network Builder turns provider search results into saved networks, shows where the gaps are and finds the providers that close them. That helps you build a network. It is not a regulatory adequacy filing.

    Candor Health: verified company information
  3. 03

    Why does the data decide the adequacy result?

    Adequacy counts providers at locations. If the provider has moved, retired or stopped taking patients, the count is wrong and the network is a ghost network on paper. CMS found at least one inaccuracy at 48.74% of the directory locations it reviewed. Fix the data first and the adequacy measure means something.

    CMS Online Provider Directory Review Report, Round 3
  4. 04

    How do Quest Analytics and Candor Health fit together?

    Candor Health's verified records feed the adequacy analysis, so the filing rests on providers who are really there. Sidecar Health used Candor Health data to grow from 4 states to 50 while its provider footprint went from 1.12 million to 7.3 million NPIs.

    Sidecar Health case study

Who does this

Who measures network adequacy

The tool most health plans use for adequacy analysis and filings, and how it works with Candor Health.

  • Quest Analytics logo

    Quest Analytics

    Quest Analytics: QES

    Network adequacy measurement, modeling and filings for health plans since 2003. Quest says it works with 90% of payers and 30+ state regulators, and it owns the BetterDoctor attestation portal.

    With Candor Health

    Quest runs the adequacy analysis. Candor Health supplies the verified records it counts, so the result reflects providers who are really there.

FAQ

Other questions people ask

  • Yes, for adequacy analysis and regulatory filings. Candor Health does not produce those. It supplies the accurate provider data the analysis is run on.

  • Yes, in two ways. Accurate records mean the adequacy count reflects providers who are really there, and Network Builder shows where a network has gaps and which providers would fill them.

  • Candor Health delivers records by API, flat files or MCP with NPI, CCN and TIN mapped, so the data can be used wherever your adequacy analysis runs.

  • A network that looks adequate on paper because the directory lists providers who have moved, retired, left the network or stopped taking patients. Accurate provider data is the fix.

See whether the providers in your adequacy filing are really there

Send the roster. Candor Health shows which locations, phone numbers and new-patient flags are right, with the evidence behind each one.