How does Quantify integrate with a partner that already has nurse case managers?
We complement your care management program — we do not replace it. Your nurses keep the longitudinal relationship with the member. Quantify handles the specialty infusion, injection, and medication workflow end-to-end: prior auth, scheduling, medication delivery, the infusion or injection visit, 24/7 nursing on therapy-related issues, and SDOH support through dedicated Resource Coordinators. We share structured updates back to your team through a documented nurse-to-nurse handoff and post-visit notes.
What is the referral path and timing?
Referrals come in by secure online form, secure email, or fax. We need member demographics, diagnosis, prescribing provider, treatment / J-code (if known), and insurance info. Partner CM teams can refer directly; no separate provider sign-off needed at the referral stage. We acknowledge receipt within 1 business day. Member outreach (call + text) happens within 24–48 hours. Welcome call with a QSC nurse is typically within 3–5 business days.
How are members identified for the program?
We work from your claims feed. Our data analytics team — led by PharmDs with MSEP degrees — flags members on specialty therapies, current and pipeline, where the Quantify model meaningfully changes cost, clinical outcome, or experience. That clinical-plus-economic lens is what keeps the work honest: every flag has to clear both a pharmacy-clinical review and an economic-defensibility review before it becomes a recommendation. No fishing expeditions. No member is required to raise their hand. We coordinate with the prescribing provider before any clinical move.
What is the cost structure for the plan?
We are paid for the care we actually deliver. If we do not engage a member, the plan owes us nothing for that member. We stay out of network on purpose — that is what lets us deliver savings against the in-network specialty path. We bill the plan and hold ourselves to a fair-and-defensible rate the plan can audit. Member cost share depends on the plan setup; our team works manufacturer copay programs, foundation grants, and patient-assistance resources on every member's behalf to bring out-of-pocket as close to $0 as the plan allows. On HDHP/HSA plans, the IRS-minimum deductible must be met first.
How do members pay for it?
QSC patients are covered through a self-funded employer health plan. For most members, our team works hard to bring out-of-pocket as close to $0 as the plan allows — through manufacturer copay programs, foundation grants, and patient-assistance resources. On HDHP/HSA plans, federal law requires the IRS-minimum deductible be met first; on other plan types, cost share is set by the plan, and we negotiate every option to lower it. We always tell members exactly what to expect before their first dose.
What does ongoing clinical oversight look like?
24/7 nurse availability via phone, text, and the QSC member app. Daily remote monitoring of biometric data where applicable. Post-treatment notes sent to the prescribing provider after every infusion or RN visit. Care escalations follow QSC's SBAR protocol — Situation, Background, Assessment, Recommendation — the same structured-communication discipline acute-care hospital teams use to hand off critically ill patients. Every escalation gets the same disciplined framing, regardless of which nurse picks up the call.
What reporting do partners receive?
A monthly engagement report per group, delivered by the 5th of the following month: who we engaged, where they are in the program, what the plan paid, and what the plan saved versus the prior path. The same reports you would build yourself if you had the data and the time.
How do we integrate billing — EDI or email?
Both. We send 837 claims and accept 835 remittance where the plan or TPA uses standard EDI. For partners who prefer email-attached billing, we support that workflow with a Quantify-branded claims workbook — same data, your format.
