Quality Results
News and Updates for Providers
October 9, 2019
QualChoice Exchange Members Moving to Ambetter
As of January 1, 2020, QualChoice Arkansas Works and FFM plans will be administered by Ambetter from Arkansas Health & Wellness. For information about services dated prior to 1/1, please use the QualChoice My Account online portal . For information about services dated on or after 1/1, please use the Ambetter secure member and provider portals .

Both QualChoice and Ambetter are owned by the Centene Corporation, based in St. Louis, Missouri.

To join the Arkansas Health & Wellness network, go to ambetter.arhealthwellness.com . Under For Providers , select Join Our Network , and fill out the linked form, which is delivered directly to the Ambetter contracting email box.
CPC+, PCMH Performance Payments
Performance incentive bonuses have been awarded to the medical providers who had outstanding performances in the QualChoice 2018 value-based care programs. We’re proud to recognize these innovative practices and providers for helping improve healthcare for our members!
Fetal/Genetic/Genomic Testing
We receive frequent questions and appeals related to fetal and genetic testing. These tests are quite costly so using an out-of-network lab or performing unapproved tests can result in a bill of several thousand dollars. This can obviously cause a financial hardship for our members.

Fetal genetic testing should only be done when it will assist parents and providers with making decisions about managing the pregnancy. All forms of prenatal genetic testing except prenatal screening for trisomy require pre-authorization. Please review BI205 for complete details.

Genetic testing must be performed by in-network providers unless otherwise stated in the member’s plan documents. Pre-authorization is required for genetic and genomic testing and chromosome analysis, except as specifically noted in Medical Policy BI038 . See Medical Management section of Provider Manual
Wellness Appointment Outreach
Risk adjustment is an essential mechanism in accounting for the overall health and expected medical costs of our members. Accurate documentation of diagnoses by clinicians is a critical component of the risk adjustment process.

QualChoice has established a prospective risk adjustment program including telephonic outreach to assist at-risk members in scheduling their annual wellness visits. A list of high-risk members is generated monthly. Dedicated analysts then connect the member and provider by phone to schedule the visit. The provider receives a cover letter and patient profile and the member receives an appointment reminder prior to the visit. Letters are also sent to members who have been unreachable by phone. As an incentive, the member receives a $100 gift credit card when we receive the wellness visit claim.

We appreciate your help in scheduling these visits and in helping manage our risk adjustment!
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.
Aaron Sadler joined THV11 at Noon to discuss tips to stay active at any age to mitigate age-related health issues and   retain   mental sharpness.
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