Quality Results
News and Updates for Providers
October 15, 2020
Practices Awarded Performance Payments
We’re happy to work with providers, other insurance firms and state and federal groups to help PCPs move from volume-based care to value-based care. We are proud to recognize the medical providers who had outstanding performances in the QualChoice 2019 value-based care programs. Thank you for helping improve healthcare for our members! 
Flu Immunizations
We are reminding our members that it's likely that flu and COVID-19 will both spread this fall and winter and that getting the vaccine early will protect against flu and reduce the burden on the healthcare system. QualChoice members can get the vaccine at no out-of-pocket cost from any in-network doctor or at a pharmacy. Members can learn more and find a vaccine provider here. See our medical coverage policy BI010 Flu Immunizations.
Claims Timely Filing Requirements
We've seen an increase in requests for reconsideration on claims denied for timely filing. Please remember that claims must be submitted and received by QualChoice in accordance with the time frames outlined in the Provider Agreement. Claims that do not meet timely filing requirements will be denied. Please review Timely Filing in the provider manual at QualChoice.com. 
Required Pre-Authorizations
Please remember to check Services Requiring Pre-Authorization. Some of the services for which we consistently receive appeals:
  • Bone Density Scan
  • Custom Orthotics
  • Fetal Echo
  • Genetic Testing
  • Habilitative Services
  • Inpatient Mental Health
  • MRI/C
Review Pre-Authorization Tools here. For faster and smoother pre-auths, sign in to My Account to use our AutoAuth online pre-authorization system. 
COVID-19 Coverage
Amendments to QualChoice telehealth coverage and claims processing for COVID-19 testing and treatment are set to end on October 23 but are expected to be extended, pending official notification from the Department of Health and Human Services (HHS). For details on QualChoice coverage for testing and treatment, click here.
Coming Soon: Eligibility Verification Change
270/271 eligibility verification, currently provided by Optum, is expected to be transferred to Availity this month. Availity enrollment information will be posted on the Electronic Transactions page at QualChoice.com when the change takes place. Eligibility inquiries can also be made by calling Customer Service at 501.228.7111 or 1.800.235.7111.  Read more. 
NovaSys Network Transition
QualChoice members soon will be transitioned to Centene’s Arkansas (NovaSys) network. The change is expected to become effective in January. In addition to QualChoice commercial and self-funded plans serving approximately 40,000 members, the network also supports these Centene companies; 
  • Ambetter from Arkansas Health and Wellness
  • Allwell from Arkansas Health and Wellness
  • Arkansas Total Care

For contracting/credentialing with Arkansas Health & Wellness, Arkansas Total Care, and QualChoice, contact pr@qualchoice.com or arkansascontracting@centene.com. For contracting/credentialing with Novasys/Centene, contact arkcredentialing@centene.com. 
New Office Location
In early August our QualChoice offices were relocated to 1001 Technology Drive in West Little Rock. We will be sharing the former AT&T building just off Chenal Parkway near the Promenade shopping center with the offices of Centene’s other Arkansas health plans, operated by Arkansas Health & Wellness.
Inpatient Antibiotic Prescribing
Antibiotics have transformed the practice of medicine, making once lethal infections readily treatable. Prompt initiation of antibiotics to treat infections reduces morbidity and saves lives, for example, in cases of sepsis. But about 30% of all antibiotics prescribed in U.S. acute care hospitals are either unnecessary or suboptimal.

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.
QualChoice Medical Director Dr. Lubna Maruf explains 3 Things to Know about Flu Shots During a Pandemic in a recent Soiree article.  

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