Quality Results
News and Updates for Providers
January 20, 2022
Submit Requests With Appropriate Documentation

To ensure all requests are processed efficiently, please ensure all required documentation is submitted with requests. Our Provider Forms and Information page houses all forms needed for member services. On this page you can also find access forms for provider portal permissions, and appeal and request for consideration forms.
 
Please note: Appeals should be submitted only for clinical denials. Submit an appeal if your request is denied because it was deemed not medically necessary, the treatment is experimental or investigational, or if there is a lack of pre-auth when the amounts are provider liability.

Submit a request for reconsideration for administrative denials regarding timely filing, clinical edits, coding, or reimbursement.
 
If you are unsure what documentation is needed to submit a request, reach out to your provider relations representative with questions. 
COVID-19: Vaccine Information

Children ages 5 and up can now get vaccinated.
The Pfizer-BioNTech COVID-19 vaccine is now available for children ages 5 and up. The Centers for Disease Control & Prevention (CDC) recommend that children get vaccinated as soon as possible so that they can be protected from the virus and help prevent the spread of COVID-19 to others, including family members who may not be eligible for a vaccine.
While the virus tends to be milder in children than it is in adults, it can still make kids very sick and require hospitalization, and there have been cases in which some children have died from the virus. Children with underlying medical conditions are at a higher risk of becoming severely ill if they contract COVID-19.

Booster shots are now available to everyone 18 and older.
Any individual who is fully vaccinated and age 18 or older is now eligible to receive a COVID-19 booster shot. Individuals who received a two-shot Pfizer-BioNTech or Moderna vaccine can get the booster shot after at least six months have passed since their first vaccination series. Individuals who received the one-shot Johnson & Johnson’s Janssen vaccine are eligible to get a booster after at least two months have passed since their first shot.
The CDC now allows for booster shots to mixed and matched according to individual preference. For example, if a person who received the Pfizer-BioNTech vaccine wants to get a Moderna booster shot, they may do so. To schedule a booster shot, people should contact the location where they got their COVID-19 vaccine. If they would prefer to get the booster somewhere else, they can find other locations by visiting Vaccines.gov. 
Update for 270/271 Eligibility Requests

We are now using Availity for our 270/271 Eligibility requests. Please note that you cannot submit eligibility requests for future dates past the current month (example: 1.1.2022). If you need to verify eligibility for a member that is not within the current month please use the QualChoice Provider Portal or contact customer service at 501.228.7111 or 800.235.7111.
Temporary Changes to Admission Requirements
These changes will be in effect until January 31, 2022.
 
Admission to Inpatient Facilities: Due to the increase of reported COVID-19 cases in Arkansas, we will allow notification of admission to inpatient facilities up to 5 days past admission date and complete medical necessity reviews when notification is received.
Post-Acute Accommodations for Rehab Hospitals and Long Term Acute Care Hospitals: We will relax our requirements related to facility transfers including:
a.   We will not require discharging acute care facilities to obtain prior authorization for patient transfers to participating post-acute facilities. 
b.   We will not require sending facilities to provide notification of transfer to participating providers. However, we will require receiving facilities to notify the health plan of patient admission. And we will accept notification up to five days post-transfer.
c.   We will continue to conduct medical necessity review.
d.   Because we will not have visibility prior to transfer, we request that hospitals utilize our in network post-acute facilities.
 
Skilled Nursing Facilities: We will allow post admission notification and authorize up to a 7 day stay before medical necessity continued stay review.
eRemits: An Enhancement for the Paper Check Process

Our provider payment vendor, Change Healthcare, is now sending eRemits to providers who receive paper checks as payment. eRemits are secure, electronic Evidence of Payments (EOP) that providers can save electronically or print for their records. eRemits are designed to increase digital engagement with providers while driving reduced paper costs. There is no fee associated with eRemits, and they are typically more secure than paper EOP’s. 

If you have questions or would like to revert to getting paper EOP’s, please contact Change Healthcare at 1-866-943-9599.
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.
Our new "Make the Right Choice" campaign ads are now airing on local and cable networks. If you missed it, you can view it on our home page or our YouTube channel.
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QCA22-AR-H-003