Quantum Health Solutions, Inc.
Quantum Health Solutions, Inc., is the comprehensive behavioral health care management program for benefit-eligible employees of OUSDHP. Quantum offers a full range of specialty behavioral health services provided by a culturally diverse network of licensed community behavioral health programs, clinics and private psychiatrists, psychologists, and therapists/counselors.
Some people seeking behavioral health services require only basic counseling services, but for those who are in need of more extensive treatment, OUSDHP medical benefit offers an range of behavioral health services. Quantum offers centralized diagnostic and referral functions that include identification of the most clinically appropriate and cost-effective level of intervention.
Our team of professionals monitors all phases of and during the treatment process, starting with the initial request for treatment. Case managers assess the necessity and appropriateness of treatment, develop a plan for monitoring care and approve provider treatment plans with internal protocols and criteria for clinical care.
Our on-going review process monitors treatment for frequency, duration and efficiency. Alternative modalities of care are developed and recommended as circumstances dictate. We work with you to coordinate treatment planning, which provides for early identification of effective alternatives, allowing better management of care transition from acute to palliative care. During aftercare monitoring, the case manager assists the patient in making a complete transition from treatment to normal living activities. This stage guards against relapse and inappropriate re-entry into treatment.
Pre-certification process starts by calling 888-214-4001. Access to in-network coverage for mental health and substance abuse treatment, either inpatient or outpatient is through Quantum. You can contact one of our network providers and schedule an appointment, and contact Quantum to take the next step. The Quantum Case Manager, after speaking with you about your individual and special concerns, will prepare the authorization for the most appropriate service(s) to meet your specific needs. You have access to the following services:
Outpatient benefits will allow members to access care with Quantum NET and Blue Cross Blue Shield psychiatrists, psychologists and social workers for in-network coverage. *Non pre-certified and out-of-network provider claims are reimbursed at the out-of-network rate.*
Inpatient benefits will allow members to access care to Quantum NET and Blue Cross Blue Shield facilities for treatment when medically appropriate. It is important to remember that you must call Quantum for admission pre-certification. Emergency and crisis treatment require you to contact Quantum the following business day for retroactive pre-certification. *Non pre-certified and out-of-network provider claims are reimbursed at the out-of-network rate.*
Claim coordination with the plans claims administrator occurs daily with the Quantum Case Management team. If you have any questions regarding the claims process, call the plan claim administrator and if additional assistance is warranted call the Quantum Case Manager at 888-214-4001 for further assistance.