Quality Results
News and Updates for Providers

December 13, 2023

Integrated Data Solutions to Improve Patient Care

QualChoice now has the technology to deliver point-of-care alerts for chronic conditions to your Electronic Medical Record (EMR) system. This makes it easier for you to provide quality care to your patients, while also earning incentives through our provider incentive programs. Utilizing the innovative bidirectional feed ensures that QualChoice is accurately capturing and reporting our members’ conditions and allows you to have all the information needed to monitor, evaluate, assess, and treat the patient during each encounter.


This new technology can also alleviate the heavy lifting of pulling medical records for our various chart requests by allowing our organization discreet access to member records for retrieval. The bidirectional feed technology can minimize disruption in workflows, reduce administrative burdens, and allow you more time to care for your patients, thereby improving the patient experience. If you currently utilize eClinicalWorks® (eCW) or athenahealth®, the data is live. For other EMR solutions, contact us to be the first to know when it will be implemented. In addition, any provider can register for Availity® access to work in the Continuity of Care Risk Adjustment program.


For additional information regarding our integrated solutions, please email our team at [email protected]

Act 575 and Provider Exemption Status

In 2023, the Arkansas General Assembly passed Act 575, amending the 2015 Prior Authorization Transparency Act. Act 575 exempts certain healthcare providers who administer certain healthcare services from prior authorization requirements for medical services.


In accordance with this Act, QualChoice has evaluated our provider network to identify providers who meet the exemption requirements. Recently we sent a letter to QualChoice providers which outlined the criteria for meeting the exemption threshold and included your exemption status. If you did not receive a letter, or have questions about this program, please reach out to our provider relations department at [email protected] or 1-800-235-7111.


For providers who meet the exemption requirements, these changes will go into effect on January 1, 2024. Providers who do not meet the exemption threshold will still need to submit pre authorization requests for medical services as outlined in our Services Requiring Pre-Authorization list. You can find more information related to pre-authorization requests and appeals in our Provider Manual. Providers servicing members who are enrolled in self-funded employer groups are excluded from the exemption process.


Thank you for your continued partnership in providing quality, cost-effective care to QualChoice members.  

Medicare and Marketplace Medical Record Retrieval

QualChoice is committed to improving the quality of care provided to our members. We are required by the Centers for Medicare & Medicaid Services (CMS) to submit complete diagnostic data regarding members enrolled in QualChoice health plans. Accordingly, we request your cooperation to facilitate a medical record review.

This year we have partnered with Datafied® and Ciox® to conduct the medical chart review. A representative from these vendors will work with you to provide retrieval options and a list of the requested members’ medical records. Questions regarding Risk Adjustment medical record reviews can be submitted to [email protected].

Clinical Documentation Improvement 

Proper coding and documentation are essential components of quality care. Remember to include all active ICD-10 codes on the claim and support active conditions in the medical record. Coding information is available and can be found on our website under the Provider Manual tab. Coding training is also available and can be tailored to your facility needs.


For more information on how to improve your clinical documentation practices, contact us at [email protected]

Medical Coverage Policies Updates

View a specific medical coverage policy.

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.

Do you know the differences between Medicare and Medicaid? Check out this recent article featured in the Log Cabin Democrat.

View Provider Forms
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