Quality Results
News and Updates for Providers
June 6, 2018
Medical Records Collection for IVA
Complete Provider Resource will be contacting QualChoice providers in July to request member records with dates of service from January 1 to December 31, 2017 for the Initial Validation Audit (IVA), in compliance with the Affordable Care Act (ACA). 
Orthotic Devices Require Pre-authorization
  • Orthotics either require PA (custom products), or are not covered (off-the shelf products), except for specific devices listed in BI217.
  • Specific back braces covered without PA are listed in BI534 with their required diagnoses. If not listed, device is not covered.
  • Specific knee braces covered without PA are listed in BI553. Custom orthotics require PA.
  • For coverage of shoe inserts refer to BI198 and BI039.
ARBenefits: Medical Necessity Review Required for Transplant
Transplant procedures for ARBenefits members with Medicare as primary payer must be reviewed for medical necessity by Active Health Management prior to the procedure. Please contact AHM at 1.877.815.1017 and press option #2 for pre-certification. This applies to transplant procedures only.
New Pre-Auths Available through AutoAuth®
OB ultrasound and DRG notifications are the newest services available for pre-auth via our automated, evidence-based pre-authorization system. All maternity notifications are now handled via the AutoAuth system as well.
AutoAuth makes it easy for you to request authorizations and supply clinical information. Sign in to the  My Account provider portal  to learn more and get started!  New services are being added regularly.Your  Provider Representative  can help with any questions.
Using the ECHO Health EFT Payment System
Now get faster EFT payments with ECHO Health, Inc. Funds are now issued from ECHO Health instead of from QualChoice. 
Opioid Misuse and Guideline for Prescribing
Deaths from prescription opioids-drugs like oxycodone, hydrocodone, and methadone-have more than quadrupled since 1999, according to the  Centers for Disease Control . Risk of addiction is high, and abuse and misuse are widespread. The CDC offers guidelines for prescribing .
CPC+ Updates and Reminders
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
Susan Jones of QualChoice joins KARK to discuss ways to work out, even if you hate to sweat.

In the Community
Project Fresh Start    ---   08/11/18
Walk With Me    ---   08/18/18
One Walk    ---   10/28/18
Race For The Cure    ---   11/03/18
Dove Tree Wrapping Party    ---   Dec., 2018 (date TBA)
1805 MK 003