Quality Results
News and Updates for Providers
September 10, 2018
QualChoice CPC+ Performance Bonuses
Congratulations to these providers  for their outstanding performance in the QualChoice 2017 Comprehensive Primary Care Plus program! Thank you and congratulations to all PCPs participating in the program!
AutoAuth ® Update
Thank you to all providers who are using our AutoAuth® online pre-authorization system! Use of the AutoAuth system is not required for pre-authorization requests. We do, however, encourage you to use the system for faster and smoother pre-authorizations.
AutoAuth is available 24 hours a day and is easily accessed through the My Account provider portal at QualChoice.com. Documentation can be submitted with the click of a button, and most authorizations are immediate. Reminder: Joint replacements may be authorized via AutoAuth, as well as many other services.  See all.
Home Sleep Studies
Home sleep studies must be performed by a Joint Commission-accredited ambulatory Independent Diagnostic Testing Facility (IDTF). If obstructive sleep apnea is documented, a CPAP device (E0601) can be prescribed for home use unless sleep lab titration due to severity of OSA or other complicating factors is recommended.
In-home sleep studies (G0399) or other unattended sleep studies (95800, 95806) are available in Arkansas without pre-authorization through Instant Diagnostic Systems (800-355-0691) or VirtuOx (877-337-7111).  Pre-authorization is only required if more than 2 studies are performed in 12 months.  

If patient has significant illness such as chronic obstructive pulmonary disease, congestive heart failure, or others, then OSA may be diagnosed in a sleep lab and will require pre-authorization.
Review our complete Obstructive Sleep Apnea (OSA) Medical Coverage Policy here. 
Claim Frequency Codes
We are seeing many claims filed with a claim frequency code when there is already a paid claim in history. Claim frequency codes are:
  • 1--Original Claim
  • 6--Corrected Claim
  • 7--Replacement of Prior Claim 
  • 8--Void/Cancellation of Prior Claim
In Box 22  ( Resubmission code)      
  • Use 7--Replace billing to notify us of a corrected or replacement claim.
  • Use 8--Void billing to let us know you are voiding a previously submitted claim.
  • Use QualChoice original claim number for Original Ref.
Please refer to the Provider Manual Claims Filing section.
Medical Records Collection for IVA
Complete Provider Resource began contacting QualChoice providers in July to request member records from January 1 to December 31, 2017 for the Initial Validation Audit (IVA), in compliance with the Affordable Care Act (ACA). Thank you for your cooperation in this important time-sensitive request.
Arkansas Works
Many QualChoice members have coverage through the Arkansas Works program and must meet a work requirement each month. Our dedicated Arkansas Works customer service reps can act as registered reporters for members, to report their work activity or exemptions at  accessarkansas.gov. Information and links to resources are available at QualChoice.com.
AMS Conferences
Our Provider Relations representatives look forward to sharing important QualChoice updates for 2019. Please plan to attend the Arkansas Medical Society's 15th Annual Insurance Conferences :
  • October 2-3 Little Rock
  • October 11 Fayetteville
  • October 18 Jonesboro
Medical Coverage Policies Updates
New on QualChoice.com
Immunization Education
To educate members on the importance of vaccines, we have posted information on QualChoice.com. Also posted is video of Dr. Win Hammerly's appearance on KARK 4 to educate parents and others about how vaccines work, how many lives are saved annually by vaccines and benefits vs. risks. At QualChoice.com we also link directly to the CDCs immunization schedules.
Updated Forms
To make sure you are using current QualChoice forms, please download directly from the Forms page at QualChoice.com each time you need to use one.
In the Media
Therese Bymers of QualChoice joins KATV to discuss sports safety for kids.

In the Community
One Walk    ---   10/28/18

Dove Tree Wrapping Party    ---   Dec., 2018 (date TBA)
1808 NS 007