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February 22, 2018

CPC+ News and Reminders

We're excited to announce that our medical policy Tele-Screening for Diabetic Retinopathy (BI570) went into effect on January 1, 2018. Coverage for this service can help improve metrics for diabetic eye screenings.

Also, new utilization and quality reports were made available on the My Account portal in January. These reports cover gaps-in-care and member-level detail on high cost members.

Important reminders:
  • Clinics must submit Category II CPT codes as eCQMs for these measures:
    • Controlling Blood Pressure
    • HbA1c Poor Control
    • Tobacco Use
  • Care Management Fee payments are made through the normal claims process and are posted on your Remittance Advice.
  • The Provider Specialty Cost Data Report is available in the CPC+ section of My Account at QualChoice.com. This spreadsheet can be used to direct referrals to the most efficient specialists and includes current data for Efficiency Ratio, Patient Risk and Number of Episodes.
For questions, refer to the CPC+ Participating Provider Training document or  find the answers to FAQs here . You can also email your questions to QualChoice at CPC+@QualChoice.com .
QualChoice Health Insurance  | 800.235.7111  | newseditor@qualchoice.com  | QualChoice.com

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