Quality Results
News and Updates for Providers
July 1, 2019
New QualChoice Ownership
QualChoice is now under the ownership of the Centene Corporation, based in St. Louis, Missouri. Centene operates in Arkansas through Arkansas Health & Wellness and Arkansas Total Care. They provide healthcare to over 200,000 Arkansans through their Ambetter health insurance marketplace plans and Arkansas Total Care Medicaid and Allwell Medicare Advantage products. 

There are currently no plans for changes to QualChoice members' benefits or provider networks. We're pleased to be part of the Centene family!
Change in ACH Payment System
Effective July 1, ACH payments and the corresponding 835 remittances will no longer be distributed through Optum Bank. If you are currently receiving ACH payments from Optum and would like to continue receiving them, two options are available.
Risk Adjustment Data Validation Audit
The Department of Health & Human Services (HHS) recently initiated audits of health plans subject to risk adjustment under the Affordable Care Act (ACA). QualChoice is included in the audit and we, along with our contracted providers, are required to fully comply.  Read more.
Requests for Urgent or Expedited Pre-authorization
For urgent or expedited pre-authorizations, please use the Pre-authorization Request Form-Clinically Urgent or Expedited, found at QualChoice.com. The patient must be in an urgent condition when using this form to request pre-authorization of services. Read more.
2018-2019 Flu Shot Campaign Successful
Getting a flu shot paid off for members whose names were drawn from flu shot claims between October 1, 2018 and April 30, 2019. One cash prize of $2,000, one for $1,000 and multiple $500 prizes were awarded. A big thank you to these providers for administering the highest number of shots to QualChoice members!

Gregory Whorton
David Slay
Mark Larey
Matthew Hulsey
Mitzi Washington
John Wornock
Scott Winston
Zane Henley
Robert Young
Jeff Carfagno
Keeping the Quality in QualChoice
QualChoice is committed to improving care and service for our Members and Providers. We maintain a Quality Improvement Program that specifies processes to carry out this ongoing commitment.
Our quality goals are based on a review of programs and services; regulatory, contract, and accreditation requirements; and strategic planning. Some key projects for this year involve first trimester maternity care, women's breast and cervical cancer screenings, well child care and PCP follow-up appointments after hospital stays. Learn more about  QualChoice Accreditations and Quality
Medical Coverage Policies Updates
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
May was National Physical Fitness and Sports Month. Susan Jones joined KARK at Noon to discuss 10 simple fitness tips to help you stay active and become healthier.
Community Spotlight
QualChoice has been a longtime corporate partner of  Easterseals Arkansas . We salute this fine Arkansas non-profit for assisting children and adults with disabilities!
1904 MK 018