Quantum Network Compliance Program:

Could your FL managed care organization be contracting with unlicensed administrators?

Could you be subject to fines up to $10,000 per occurrence?

Did you realize that even sub-capitated payments from MSOs, or single specialty networks, to their downstream providers may constitute payments under what FL Statutes define as a "Health Care Risk Contract" and could require an Administrator License?

Did you realize that the Florida Office of Insurance Regulation can cancel contracts with your MSOs and single specialty networks if they’re operating as unlicensed Administrators?

Quantum Care Network Compliance

The Quantum Network Compliance Model will:

Allow your MSOs and Single Specialty Networks to be represented by a Florida Licensed Third Party Administrator at a cost effective rate.

Quantum Care, LLC will load the MSOs’ or Single Specialty Networks’ contracts in to the Quantum Care, LLC system and will make timely downstream payments and will report back to the HMO when all downstream contracts have been made in accordance with the Network entity’s contracts. THIS PROVIDES THE HMO WITH A 100% AUDIT OF MONTHLY DOWNSTREAM PAYMENTS.

Quantum Care, LLC will do a verbiage review of the network contracts to ensure that downstream provider contracts have verbiage required by Chapter 641.

Big Benefits for the HMO:

Compliant downstream contracts

Never wondering if downstream payments have been made…less financial risk.

No risk of hefty fines associated with contracting with "unlicensed Administrators."

No risk of membership loss associated with MSO contracts being terminated by regulatory bodies for lack of an Administrator’s license.