Quality Results
News and Updates for Providers
April 27, 2021
COVID Waiver Updates
QualChoice will continue to cover COVID testing and vaccinations at no member cost share but effective June 1, 2021, QualChoice will reinstate member cost sharing for telehealth and COVID treatment services. However, we will not reinstate pre-authorization requirements for COVID-related services at this time. For questions about the COVID-19 services QualChoice covers, please contact Provider Services at 501.228.7111, ext. 7004.
Upcoming Changes to Clinical Editing Rules
QualChoice will be implementing three new clinical edits effective September 1, 2021. These edits are industry standard for Medicare, Medicaid and other commercial payers. If you have any questions please contact our contracting team at [email protected].
  • Bilateral – The same code performed bilaterally should not be billed twice when reimbursement guidelines require the code to be billed once with a bilateral modifier. The clinical edit will identify the same code billed twice for the same date of service, where the first code has the bilateral 50 modifier appended. The edit will deny the second submission regardless if it is submitted with or without a bilateral modifier.  
  • Add-on Codes without Base Codes – Add-on codes are always performed in addition to the primary service or procedure and must never be reported as a stand-alone code. The edit will deny all add-on codes when billed without a primary parent code.
  • Multiple Radiology Services – It is common for multiple radiology procedures to be performed simultaneously. The edit will apply a multiple radiology payment reduction when multiple procedures are received or specific modifiers are added to a radiology code.
High Tech Imaging Change
Effective March 1, 2021, National Imaging Associates, Inc. (NIA), a subsidiary of Magellan Health, is managing diagnostic (MRI/CT/PET) and cardiac imaging services through QualChoice contractual relationships. Learn more here and by visiting the QualChoice.com Utilization Management & Pre-authorization page.
Lawrence Health Hospital Services Pre-authorization List
In an effort to make it easier for members and providers to locate, there are now links to the Lawrence Health Hospital Services pre-authorization list available on QualChoice.com. Providers can now directly access the SHARP pre-certification information by navigating to QualChoice.com/For Providers/Pre-authorization List. 
Avoid Imaging for Lower Back Pain
Lower back pain (LBP) is one of the most common reasons for an outpatient visit. Keep in mind that an X-ray to help diagnose and treat this issue is not recommended until at least six weeks after the onset of the pain. Performing an X-ray does not improve outcomes and could expose the patient to unnecessary radiation and costs. The evaluation for LBP should include a complete, focused medical history that looks for red flags, including, but not limited to, neurological deficits, fever, trauma and underlying conditions. It is also important to rule out any nonspinal causes before determining a treatment plan.
Updated Forms
In the Media
To make sure you are using current QualChoice forms, please download from the Provider Forms page at QualChoice.com each time you need to use one.
The QualChoice Communications team provided tips for caring for special needs kids during difficult times, published online by Little Rock Family magazine. 
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