Quality Connection

News and Updates for Brokers
December 18, 2017
Secure Payment Address Change
Group health plan members recently received notice that QualChoice secure payments must now be sent to:
QualChoice
PO Box 677272
Dallas, TX 75267 

This change is already in effect. For questions, please call the QualChoice Finance Department at 501.228.7111, ext. 7023.
No Out-of-State Coverage for Individual Metallic Members

Non-emergency services provided outside the QualChoice service area for Individual Metallic Members will require pre-authorization in 2018. This means elective services by out-of-network providers outside Arkansas will not be covered by the member's policy. NOTE: These limits do not apply to emergency services or out-of-area dependents.

 

Providers have been reminded to:

  • Identify QualChoice individual metallic members by their Select network ID cards before making elective service referrals.
  • Check the QualChoice provider directory and refer these members to providers in the Select Network only.

If the service is not available from a Select Network provider, you may request pre-authorization and a referral by contacting QualChoice Care Management at 800.235.7111, ext. 7014.
New Drug Formularies
New formularies ----- prescription drug lists ----- for 2018 have been posted at QualChoice.com in the Already a Member section. Select Pharmacy and Drug Formularies. Members who are not sure which formulary their plan includes may sign in to My Account or check with their employer or plan sponsor.
Changes to Member Explanation of Benefits (EOB)
To improve member communications, QualChoice is making these changes to member statements (EOBs):
  • Periodic EOBs will be sent out every 14 days based on oldest service paid. 
  • EOBs will contain multiple services from different providers during the 14-day period. 
  • If a payment is made to a member, the 14-day period will be disregarded and an EOB immediately issued. 
  • Service descriptions are easy to read and understand. 
3-D Mammogram Coverage

Due to an Arkansas law that went into effect August 1, 2017, doctors may now order 3-D mammograms for routine breast cancer screenings at no additional cost to the patient.
QuicRewards Spotlight
This month's featured product is the FitBoomBah 7-Day Meal Plan, custom-designed by a registered dietitian to meet an individual's health needs and goals. Offer details for QualChoice members:
  • Pay just $80 for the Personalized Meal Plan-a 20% discount off the $100 retail price. 
  • Get a portion-controlled plate divider to help keep serving sizes in line. 
  • Get a BPA-free portable water bottle.
To get the discount, members must show their QualChoice ID card. Visit QualChoice.com to see all QuicRewards offers from leading Arkansas health-related companies.
PCP Assignment and Specialist Claims
All members of QualChoice individual metallic plans (Bronze, Silver, Gold, Platinum and Catastrophic) were required to choose a primary care provider in 2017, and this policy will continue in 2018. Members who do not choose a PCP will be assigned one based on their claims history, but will be allowed to change their PCP if needed. Members who have not seen their assigned PCP will be placed in an unassigned PCP status. Before seeing these members, specialists will need to refer them to PCPs.
Updated Forms
To make sure you are using current QualChoice forms, please download from the Broker Forms page at QualChoice.com each time you need to use one.
View Broker Forms
In the Media
Lisa Baker of QualChoice joined KATV Good Morning Arkansas to share tips on staying healthy during the holidays. You can also read the related article in Soiree.
See the Video
In the Community
2017 Dove Tree Wrapping Party
Save the date!  Join us on December 16, 2017!



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