We are pleased to inform you that QualChoice is publishing policies to inform providers about acceptable billing practices and reimbursement methodologies for procedures and services. We believe that publishing this information will help providers bill claims more accurately, thereby reducing unnecessary denials and delays in claims processing and payments. 

We will apply these policies as medical claims reimbursement edits within our claims adjudication system. This is in addition to all other reimbursement processes that we currently employ. 

These policies are developed based on medical literature and research, as well as industry standards and guidelines as published and defined by the American Medical Association’s Current Procedural Terminology (CPT®), Centers for Medicare & Medicaid Services (CMS), and public domain specialty society guidance, unless specifically addressed in the fee-for-service provider manual published by the state of Arkansas or regulations. 

Visit QualChoice.com to view our policies. The effective date for the below changes is December 1, 2026: 

• ABA Requirements 
• RBT and BCaBA Reimbursement Changes 
• BCBA Reimbursement Changes 

What is changing? 

• ABA Requirements: 
• The individual who renders Applied Behavior Analysis (ABA) services must be listed as the rendering provider on all submitted claims. 
• RBT and BCaBA Reimbursement Changes: 
• Reimbursement for Registered Behavioral Technician (RBT) and Board Certified Assistant Behavior Analyst (BCaBA) services will be updated to 50%. 
• BCBA Reimbursement Changes: 
• Board Certified Behavior Analyst (BCBA) services currently being reimbursed at 85% will be reduced to 75%. 

Providers must submit the Arkansas Provider Roster Template to ensure all rendering providers, including RBTs and BCaBAs, are loaded into the system and available for billing. The Arkansas Provider Roster Template is available on our Provider Resources page at ARHealthWellness.com.

Which products are affected?  

This notice applies to QualChoice. 

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.