Submitting Referral and
Pre-Certification Forms

Care Coordinators by Quantum Health is consistently recognized by office staffs nationwide as having one of the easiest and most efficient notification processes in the industry. A "notification of referral" process enables the Care Coordinators to assist physicians and patients to coordinate services, by confirming that providers are in-network, services are covered, and patients receive their enhanced benefit. We also ask for Pre-Certification for certain procedures – listed on each patients’ ID card – to ensure coverage under plan criteria and prevent back-end denials. Our standard turnaround time for notifications is 24-48 hours!
Please Note: Once registered with an account with us, you can view the status of your authorizations by selecting "Referral and Pre-Cert Authorization" in the menu on the left!

If you're completing a Pre-Certification for Chemotherapy or Radiation please complete the following form and fax it to 800-973-2321:
Chemotherapy/Radiation Precertification Questionnaire

There are three ways in which you can submit a pre-certification or referral notification:

Submit Form Online

Precertification/Referral Form
Print Form and Fax

Precertification/Referral Form
Please fax to 800-973-2321
Call to Submit

A Care Coordinator is happy
to assist you at 800-247-8956
Please Note: While routine labs or X-rays do NOT require referral or pre-certification, MRIs and MRA’s DO require pre-certification. For a complete list of pre-certification requirements, please reference the patients ID card.

The following services typically require prior authorization. However, the requirements may vary based on the employer so please refer to the member ID card for the list of services needing precert for that member.

  • DME Purchases over $500 & all rentals
  • Dialysis
  • Inpatient Admissions
  • Home Health Care and Services
  • Hospice Care
  • MRIs/MRAs & Pet Scans (regardless of place of service)
  • Oncology care and services (chemotherapy, radiation therapy etc.)
  • Outpatient surgeries
  • Speech, Physical and Occupational Therapies
  • Skilled Nursing Facility Admissions
  • Transplants: Organ and Bone Marrow

The primary utilization criteria is Interqual.

For the quickest turnaround, please submit any history/clinical information that supports the need for the requested pre-certification with this form. You may fax this info to 1-800-973-2321.
For assistance, please contact the Care Coordinators at