Adequacy API Developer Guide

The QES Adequacy API Developer Guide explains how to programmatically determine whether the provider coverage for each specialty by county meets regulatory requirements. Maintaining the adequacy of your provider network reduces regulatory risk and maximizes member satisfaction.

For example, using the Adequacy API you can:

• Determine the counties in your network that fail to meet the regulatory guidelines.

• Export the network adequacy data in the health services delivery (HSD) file format required for upload to HPMS.