Insurance Administration Services (IAS)Cost Containment (CC)Medical Risk Management Solutions (MRMS)Business Consulting Solutions (BCS)Contact Us
Our Services
We help deliver better results to your bottom line!
- Experienced – Our staff has international payer handling experience. Management has over 30 years’ industry experience. We know international client and member needs.
- Reputable – The network is comprised of recognized healthcare providers.
- Results Driven – We analyze your claims, cut costs without sacrificing the quality of care or services and manage costs. At the end of the day, clients ask us to “Show them the money!” We are skilled and resourceful in saving money for our clients.
Insurance Administration Services
Insurance Administration Services offers clients:
- Customized health plan administration
- Medical costs analysis including discounting and reporting
- Claims processing & management
Our service includes customization for each client.
Quantum Health Management, LLC prides itself on its experience managing medical costs and maintaining a high rating of customer service for its members. We can manage your account and patient care by offering:
- Hospital & Physician Network access (both in the United States and globally)
- Customer care from an elite team of Patient Care Advocates
- Claims Management
- Medical Case Management including access to URAC accredited services
- Account Management and reporting
We can provide customized network design and management. We offer support including print your ID cards, issuing guarantee of payments, answering member service calls, communication with providers, interfacing with client claims systems, claims processing support including discounting, issuing EOBs and payments, as well as communicating insurer decisions about member claims.
Our support includes claims handling, review for accuracy, and confirmation that amounts payable to provider are based on client plan benefits.
- Network management and customization
- Proactive Rate Negotiation with providers
- Thorough costs analysis of medical services
- Access to support tools enhancing claims discounting
- Auditing and claims review
- Negotiation of claims & discounting
- Claims Risk analysis
Cost Containment
Our in-house medical management team proactively negotiates with providers to reduce claims costs.
Medical Risk Management
To ensure patients receive the right care, we implement a strong utilization management program. Case management is a valuable tool in ensuring that providers deliver appropriate, cost-efficient services. Our team performs a clinical review to assess whether we can save you money while providing your members with the same or better level of service.
In order to ensure members receive the appropriate care at the right time, our case management team review cases throughout the continuum of care including:
- Prospective Review: Before authorizing treatment, we evaluate the medical necessity and appropriateness of care.
- Concurrent Review: During treatment, we intervene on coordination and transition of care and discharge planning.
- Retrospective Review: When treatment concludes, we assess the appropriateness of the procedure and additional or others treatments in order to improve costs.
- Benefit design consulting- Benefits tailored to include the needs of members rather than using standard benefit designs
- Prescription drug formulary design in collaboration with a pharmacy benefits management (PBM) firm
- Benefit bundling (e.g. medical benefits with dental)
- Travel Insurance policy design
- Auditing of medical claims
- Wellness design, Affinity Benefits and other programs
Business Consulting Services
Our team of seasoned professionals offers a wide array of professional consulting services.