QualChoice is providing notice of the Network Quality Standards policy. This policy outlines quality standards, quality programs and initiatives, and oversight activities that in-network providers must follow and/or participate in.

The policy establishes participation expectations for Plan quality initiatives and oversight activities, including timely responses to Plan requests, completion of required documentation, and engagement in identified quality initiatives or programs as applicable to the provider’s scope of services.


Providers are expected to support continuity of care, appropriate transitions between levels of care, applicable certification requirements, and any quality-related contractual requirements or Plan communications.


To view our clinical and payment policies, visit QualChoice.com and select Medical Coverage Policies from the For Providers menu. The effective date for the below policy is November 1, 2026:

• Network Quality Standards (Policy ID: AR.NTWK.113)

What is changing?

QualChoice is implementing the Network Quality Standards policy to define in-network provider expectations for participation in Plan quality initiatives and oversight activities. These activities may include care management programs, Quality of Care reviews, risk adjustment activities, Special Investigations Unit requests, telehealth-related review, transition-of-care expectations, certification requirements, and review by the Plan’s Network Quality Review Committee. Providers whose level of participation or service delivery model does not demonstrate compliance with network quality standards may be subject to additional review and may be determined non-compliant with network quality standards, which may result in corrective action or network termination as outlined in the policy.


Which products are affected?

Ambetter from Arkansas Health & Wellness, QualChoice, and Arkansas Total Care.


As a participating provider, you have options available to you if these changes are not acceptable. Please refer to Article VII in the terms and termination section of your participating provider agreement. If you have any questions, please contact our contracting team at 1-800-235-7111, or email us directly at ArkansasContracting@centene.com.