Behavioral Healthcare Management

 

Providing cost containment and a return on investment are benefits to be realized by the employer when implementing Quantum’s  Behavioral Health Management (BHM) services.  As the first step, our BHM program offers centralized diagnostic and referral functions that include identification of the most clinically appropriate and cost effective level of intervention and referral to the appropriate Quantum behavioral network provider.  The BHM component monitors all phases of the treatment process, starting with the initial request for treatment.  Quantum 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.

The Quantum cohesive model of BHM give the opportunity to better determine the depth of clinical services by tracking the level of care needed while monitoring expected outcomes and cost of services. This is achieved by coordinating with the Client organization, Quantum Case Managers and behavioral health network clinicians.

PERFORMANCE STANDARDS:

 

  • Quantum will assess overall accuracy of client diagnosis and their placement, client assessment, development and monitoring of individual care plans.

 

  • Conduct Review of services received without pre-authorization via reports from Plan Administrator.

 

  • Conduct review of ongoing care through network providers to effect individual client outcomes.

 

  • Conduct assessment for intensity of service for individuals to determine appropriateness.

  

  • Review and illustrate large case populations or individuals

 

 

  • Quantum will ensure that all subscribing members who are referred to a network provided for clinical services are assessed and tiered as appropriate.

 

  • Quantum utilizes internal protocol in coordination with Plan Administrator policies and procedures.

 

  • All concurrent and retrospective reviews shall be completed as outlined in the Quantum Policy and Procedure guidelines manual.

 

  • Quantum shall ensure that all authorizations will be distributed to the network provider within four business days and urgent authorizations by close of business.

 

  • Quantum shall review and approve/deny excess utilization requests and exception to Policy periodically with the Plan Administrator.

 

  • Quantum shall provide agreed upon criteria indicator reports monthly or quarterly, and periodic as required.

 

  • Quantum shall ensure a 98% accuracy rate on all transactions that result in a network provider reimbursement and/or adjustment.

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