About Us

Today’s Solutions for Today’s Challenges.

As a provider cost management company, Quantum One’s “today’s” technology streamlines, accelerates and simplifies processes while eliminating unnecessary costs and waste. Payors and Third-Party Administrators (TPA) want faster, more accurate methods of integrating new processes to address their “today” needs. Even if a Payor or TPA is ready for real-time processing, Preferred Provider Organizations (PPO) and Ancillary services are not. Updating or making changes to a legacy system is cumbersome and difficult and requires time and expense. The services Payors or TPAs require should be available at their fingertips to give them more control over the entire process. The challenge? Vendors do not want to relinquish their control and the revenue they might lose. Quantum One (QON) is the solution for this dilemma.

Who We Are

Quantum One is a provider cost management technology company that provides:

Today’s technology for real-time processing
One Application Programming Interface (API) for all Preferred Provider Organization (PPO)/Ancillary repricing
One point of contact for Payor and TPA vendor services
Returning control and choices to the Payor and TPA for additional PPOs/Ancillary Networks with no additional bill review costs
Increase Payor and TPA net savings by reducing or eliminating bill review company costs/fees for multiple PPO bridges, handling or repricing of PPO and Ancillary claims
Value network stacking for greater savings
Ease of adding client requested PPOs to QON’s value stacking
Additional savings below legacy system bill review fee schedule/UCR repricing
Seamless integration for Payor and TPA processes

Network

QON provides access to providers, facilities and specialty networks in all jurisdictions of the country for comprehensive coverage. With over 2.1 million providers throughout the United States, we can meet any client’s jurisdictional needs while not losing sight of the personal touch that is required for even the smallest network. Our Priority PPO value stacking achieves greater than 16% nationwide savings averages below state fee schedules or Usual and Customary. In California, we have years of experience developing and managing custom Medical Provider Networks (MPN) with proprietary provider contracts.

Technology

QON specializes in medical technology solutions. With systems for developing and managing customized networks, maintaining provider information, demographics and contracting and credentialling of providers, to sophisticated repricing system with custom carveout logic for special provider contract language, client directed repricing system (API) for real-time adjudication, and e-billing solutions (clean bills – 837, remittance – 835, Electric Funds Transfer (EFT), data quality and integrity). We also provide medical technology expertise for clients that have special IT needs. With certified project management experts, we can assist with any requested or required IT needs.

Commitment

Our commitment is to provide a network and strategy that perfectly blends vision, expertise and technology to achieve better outcomes for the delivery of effective medical care, faster recovery and return to work for those who need it most – the injured worker. We are also committed to provide the needed technology to expedite processes required for all the stakeholders involved. Real-time solutions for real-time results.

What We Do

Quantum One real-time solutions allow our clients to access the medical community in a more effectively way to give greater control and improve outcomes. Here is a sampling of what is available to you:

Sophisticated network repricing system for real-time adjudication (API)
Access to local and nationwide networks for better penetration
Choices and control of providers, facilities and hospitals
Value PPO stacking – by state or zip code
“Proprietary” provider contracts that assists to minimize provider abuses
Electronic e-bill solutions
EDI bride services (837/XML/client specific requirements)
Real-time Provider Search Utilities
Technology solutions with certified project management

In California, Quantum One applies this technology to develop, implement and manage quality outcomes based Medical Provider Networks (MPN). Because of our technology, we are able to:

Provide the injured worker with a ‘best-in-class’ network of carefully selected physicians and facilities
Proactive management, monitor and provide all services required by SB 863 to protect the compliance and integrity of the MPN
“Proprietary” provider contracts that minimizes provider abuses
Provide dedicated personalized customer service to manage providers, Transfer of Care (TOC), Continuity of Care (COC), Medical Access Assistant (MAA), disputes, grievances and all aspects of the MPN