guide
Quantum Health prior authorization: who reviews each request
Quantum Health prior authorization works differently from a typical insurer’s. Quantum Health is a care navigation company for self-funded employer plans, and it says it’s trusted by more than 500 organizations. On some plans it reviews prior authorizations, and on others another company does. The employer’s plan decides, and that can change from one plan year to the next.
This guide covers who decides a request on a Quantum Health plan, how providers reach Quantum, the State of Connecticut’s change in 2026 and the federal deadlines a self-funded plan has to meet.
At a glance
- Quantum Health is a navigation company for self-funded employer plans, not an insurer.
- Which company reviews a prior authorization depends on the employer’s plan.
- Quantum Health’s provider line is (800) 247-8956.
- Connecticut announced in 2026 that Anthem would take back its state plan’s utilization management.
- Federal rules give a plan 72 hours for urgent requests and 15 days for pre-service ones.
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Who decides a Quantum Health prior authorization
A practice can meet up to three companies on one employer plan:
| Role | What it does on the plan |
|---|---|
| Navigator, such as Quantum Health | Member advocacy, customer service and care coordination, and on some plans prior authorization reviews |
| Claims administrator | Processes claims under the employer’s plan |
| Utilization manager | Reviews whether a requested service is medically necessary |
The State of Connecticut’s 2025 plan document shows how the roles split. Quantum provided customer service and conducted prior authorizations, but took no financial risk for claims. Utilization management was done by Quantum for medical benefits and by Anthem for behavioral health benefits and prescription drugs administered by the medical plan.
How to reach Quantum Health as a provider
Quantum Health’s provider support line is (800) 247-8956, and its provider portal is called Care Coordinators by Quantum Health, according to its contact page. Its Care Coordinators can also contact providers to obtain prior approval when it’s needed.
When the employer’s plan names another company as its reviewer, the request goes to that company instead.
Keep each Quantum Health request with the company that reviews it
When a plan moves its prior authorization reviews
Connecticut’s state employee plan shows how quickly the reviewer can change:
| Role | 2025 plan document | February 2026 announcement |
|---|---|---|
| Medical utilization management | Quantum Health | Anthem |
| Member advocacy | Quantum Health | Quantum Health |
On February 18, 2026, Connecticut’s Comptroller announced that Anthem will reestablish utilization management services and that AmeriBen, Anthem’s third-party administrator platform, will oversee medical claims administration. Quantum Health continues to deliver member advocacy.
So a reviewer that was right last year may not be right this year. Check the patient’s current plan before each new request.
Decision deadlines on a self-funded plan
Whichever company reviews the request, the federal claims rule for ERISA group health plans (29 CFR 2560.503-1) sets the limits. An urgent request is decided within 72 hours, and a pre-service request within 15 days, extendable once by up to 15 days for matters beyond the plan’s control. Self-insured non-federal governmental plans, such as state employee plans, follow the same rules under 45 CFR 147.136.
The same rule sets the appeal limits:
- 180 days
- minimum time to appeal a denial
- 30 days
- to decide a pre-service appeal with one level of appeal
Silna’s guide covers how to appeal a prior authorization denial step by step.
Where Silna fits on a Quantum Health plan
Silna confirms which company reviews each request, submits it there and follows up until a decision comes back. It handles prior authorizations under both medical and behavioral health benefits, including payors that review the two separately, as Connecticut’s 2025 plan did.
G2 reviewers rate Silna 4.8 out of 5 across 66 verified reviews. When Anthem is the reviewer, see Silna’s guide to Anthem prior authorization.
Skip the follow-up calls on every Quantum Health request
Key terms
- Care navigation
- Helping a plan’s members with benefits questions, providers and care coordination.
- Claims administrator
- The company that processes claims for a self-funded plan.
- Utilization management
- The review of whether a requested service meets the plan’s medical necessity criteria.
- Self-funded plan
- An employer health plan where the employer pays claims itself and contracts out administration and review.
Frequently Asked Questions
Is Quantum Health an insurance company?
No. It’s a care navigation company for self-funded employer plans. Connecticut’s 2025 plan document says it took no financial risk for claims.
Does Quantum Health approve prior authorizations?
On some plans. Connecticut’s 2025 plan had Quantum handling medical utilization management, and in 2026 the state announced that Anthem would take it back.
How do providers contact Quantum Health?
Call (800) 247-8956, or sign in to the Care Coordinators by Quantum Health provider portal.
Which prior authorization form does a Quantum Health plan use?
The form or portal of the company the employer’s plan names as its reviewer, which can be Quantum Health or another company.
This article is general educational information and does not give medical, legal or insurance advice. Each employer’s plan sets its own rules, so check the patient’s current plan before you rely on it.
About the author
Jeffrey Morelli
Jeffrey Morelli is the Co-Founder and CEO of Silna Health, the first Care Readiness Platform built to remove the administrative barriers that delay care. Silna automates benefit checks, eligibility, and prior authorizations across 1,000+ payors, and is backed by $27M from Accel and Bain Capital Ventures. Before Silna, Jeff spent a decade in San Francisco building and scaling products for highly regulated industries, including leading go-to-market at Truework (Series C, acquired by Checkr).
Last updated: November 2, 2026.