Who is Quantum Health — State of Connecticut Employer Group and Connecticut Partnership Plans?

Background

As of July 1, 2023, the State of Connecticut employer group contracted with Quantum Health* as their healthcare navigation and care coordination service, including the State’s Health Enhancement Program (HEP) for the State of Connecticut Employer Group and Connecticut Partnership Plans. On August 1, 2023, Quantum Health also assumed contract responsibility for medical utilization management prior authorizations. Quantum Health is an independent company and is not an affiliate or subsidiary of the parent company of Anthem Blue Cross and Blue Shield (Anthem).

Anthem remains responsible for claims adjudication and for certain utilization management services, as outlined below:

• Specialty Medical Pharmacy prior authorizations
• Behavioral Health utilization management and case management

Quantum Health will redirect care provider questions/inquiries to Anthem for medical and behavioral health services for the following:

• Care provider contracting
• Remittances
• Fee schedule
• Value-based programs
• Network status
• Demographic information updates

Frequently asked questions (FAQ) 

General information

Question: The change in healthcare navigation and care coordination services to Quantum Health from Anthem; was this change initiated by Anthem?

Answer: No. Quantum Health was selected by the State of Connecticut.

Question: Are there new contact phone numbers on member ID cards because of the changes that occurred on July 1, 2023, and August 1, 2023?

Answer: Yes. All members were issued a new ID Card in June 2023, reflecting new contact phone numbers for services. See the example ID card on the next page for more detail.

Authorizations

Can medical authorization be requested through Availity*? If not, what ways can a care provider obtain an authorization from Quantum Health?

No. To obtain or request covered medical services authorizations, contact Quantum Health directly:

• Medical Provider Services: 855-671-2656
• Fax: 855-475-5963
• Care provider website: ccbyqh.com

Are authorizations obtained from Anthem prior to August 1, 2023, still relevant? How will authorizations issued by Anthem be handled?

Yes. Previously adjudicated medical authorizations performed by Anthem will be honored.

Will Anthem honor existing Carelon Medical Benefits Management, Inc. prior authorizations past July 31, 2023?

Yes. Previously adjudicated medical authorizations performed by Anthem, or its designee, will be honored.

Will Quantum Health also handle retroactive/post authorizations and urgent notifications as well?

Yes. Quantum Health will process medical retroactive and urgent notifications. Note: Behavioral Health and Specialty Medical Pharmacy authorizations will continue to be adjudicated by Anthem or its designee.

Can Quantum Health authorizations be viewed in Availity?

No. Quantum Health-issued authorizations will not appear in Availity. Inquiries for issued authorizations can be directed to Quantum Health:

• Medical Provider Services: 855-671-2656
• Fax: 855-475-5963
• Care provider website: ccbyqh.com

If a medical authorization is attempted to be entered into Availity, will Availity re-direct you to Quantum Health? Currently Availity does not stop you for Optum members.

No. However, a screen alert will provide instructions for care providers to contact Quantum Health.

Will Quantum Health publish or make available authorization requirements for specific CPT^® codes for care providers?

Quantum Health can provide guidance on authorization requirements by calling Quantum Health Medical Provider Services at 855-671-2656.

Are there any training sessions/tutorials offered by Quantum Health to submit an authorization?

Care providers who need guidance on processes and how to submit an authorization or have questions should call Quantum Health Medical Provider Services at 855-671-2656 or review content on their care provider website at ccbyqh.com.

Anthem Designee — Carelon

What services will Anthem or its designees retain for the State of Connecticut and State Partnership Plan accounts?

Anthem is responsible for claims adjudication and for certain utilization management services, as outlined below:

• CarelonRx, Inc.* clinical review of all specialty drugs
• Carelon Medical Benefits Management – specialty pharmacy (oncology)
• Carelon Behavioral Health, Inc.* utilization management and case management

If care providers have questions on an authorization, claim, or benefits for an Anthem designee service and need to speak to someone, should care providers be calling Quantum Health?

Yes. The State of Connecticut has chosen Quantum Health as the front-line contact for all member, care provider, and claim inquiries. Call the Medical Provider Services line 855-671-2656 and follow the telephone prompts, as applicable, to your inquiry.

Claims (Medical Specialty Pharmacy and Behavioral Health)

Will reimbursement for claim payments be issued by Anthem or by Quantum Health?

Reimbursement for claim payments will continue to be issued by Anthem.

Will claims still go through HART/PRIME systems?

Yes. Anthem is retaining claims adjudication based upon the state’s benefit plan and, in certain circumstances, information for direction provided by Quantum Health.

Is Quantum Health responsible for processing claims?

No. Anthem is retaining claims adjudication responsibility based upon the state’s benefit plan and in certain circumstances information for direction provided by Quantum Health.

Will adjudicated claims be viewable on Availity?

Yes. Adjudicated claims will be viewable on Availity.

What does it mean that claim inquiries need to first be made to Quantum Health?

The State of Connecticut has chosen Quantum Health as the front-line contact for all member, care provider, and claim inquiries.