Quality Results
News and Updates for Providers
March 1, 2019
High-Tech Imaging Pre-auth and Appeals
We receive frequent questions and appeals related to high-tech imaging. EviCore National, LLC manages our high-tech radiology requirements, which are specified in the Medical Management section of the QualChoice Provider Manual.
 
  • What do I tell my patient when their case is denied?
  • What are my options when a case is denied?
  • How can I submit more clinical information if needed?
  • How do I start an appeal?
  • How do I schedule an online clinical consultation following a denial?
Coverage UPDATE: Mental Health and Substance Use Disorder (BI273)
Please review the updated guidelines for Outpatient Therapy for Mental Health & Substance Use Disorder medical coverage policy (BI273). 
Transitional Care Management Services
Effective January 1, 2019, QualChoice now covers transitional care management services. These services may be required for patients who are discharged from a facility stay, to help with the transition back to their usual living situation and decrease the likelihood of readmission. Review details in Provider Manual.
Member Termination Policy Update
We have updated our retroactive termination policy. Employers now have 10 calendar days after month-end to send requests for termination effective the last day of the previous month.
HEDIS Medical Records Review 
QualChoice is compiling data for reporting on our 2018 clinical outcomes to demonstrate performance against the Healthcare Effectiveness Data and Information Set (HEDIS) standards.  Complete Provider Resource personnel are contacting offices on our behalf by fax and telephone to coordinate record collections. Learn more.
It Pays to Use AutoAuth!
Thank you for using our AutoAuth® online pre-authorization system. Congratulations to these lucky users who won our drawings over the last several months!
$100 Cash Gift Cards
Julie Elton
 Central Clinic for Women, Little Rock
Ken Poag
 CHI St. Vincent, Hot Springs
Miranda Jones
 The Woman's Clinic, Little Rock
Stephanie Parker
 Cornerstone Medical Clinic, Harrison
Jessica Hunter
  St. Mary's Regional, Russellville
Stacy Metzler  
 NEA Baptist Clinic, Jonesboro
$600 Grand Prize Gift Card
Summer Dowdy 
 HerHealth Clinic, Washington Regional, Fayetteville
Sign in to the My Account provider portal to learn more about the system and get started! For questions, contact your Provider Representative .
Members Can Win Cash by Getting a Flu Shot
As you know, flu season can last as late as May. We're reminding QualChoice members that they can get the flu vaccine at any network pharmacy or provider's office. No copayment is required.
 
And we're drawing from flu shot claims to give away cash gift cards. See the schedule for cash drawings . We've also posted facts about the flu at QualChoice.com.
Medical Coverage Policies Updates
Updated Forms
To make sure you are using current QualChoice forms, please download directly from the Forms page at QualChoice.com each time you need to use one.


In the Media
Therese Bymers discussed some of the biggest health food trends on KARK's Arkansas Today show.


In the Community
Join us for a day of family fun on April 13! Race for a Healthier Tomorrow benefits Arkansas Children's Hospital. It includes a 5K race, 1-Mile Family Fun walk and a free Family Fun Fair.
1902 MK 008