Accreditation and Audits

QualChoice is committed to excellence and quality in our products and services. To demonstrate that commitment, we are audited and accredited by leading independent organizations who work to improve quality through review and reporting.

HEDIS Compliance Audit logo

NCQA—The National Committee for Quality Assurance (NCQA) is a nonprofit organization dedicated to improving healthcare quality. The NCQA seal is a widely recognized symbol of quality. Organizations displaying the seal must pass a rigorous review and report on their performance each year. Their Healthcare Effectiveness Data and Information Set (HEDIS) standards ensure that purchasers and consumers have the information they need to compare healthcare quality.

URAC—URAC is a well-known leader in promoting healthcare quality through its accrediting, education and measurement programs. URAC offers a wide range of quality benchmarking programs and services. It is a mark of excellence for organizations who wish to validate their commitment to quality. URAC ensures that all stakeholders are represented in establishing meaningful quality measures for the healthcare industry. For more information, visit urac.org.

QualChoice currently holds the following URAC Accreditations:

Urac logo hp  

QCA Health Plan, Inc.

Urac logo him

QCA Health Plan, Inc.

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QualChoice Life and Health 
 Insurance Company, Inc.

Urac logo hum

QualChoice Health Plan
Services, Inc.

 

SSAE 18 Type II—This attestation assures that an organization meets a nationally-recognized level of business finance and process standards for service organizations. The SSAE 18 Type II audit was introduced by the Auditing Standards Board (ASB) of the American Institute of Certified Public Accountants (AICPA). QualChoice has an SSAE 18 Type II examination performed each year.

Promoting Quality and Safety by Empowering our Members

We empower our members to take an active role in their care and the care of their families. We urge them to ask questions, understand conditions and treatments and evaluate options. We assist members in:

  • Choosing quality doctors and hospitals
  • Accessing health information
  • Following health and immunization guidelines

Provider Network—We know that improving healthcare quality is a team effort. That’s why our network includes some of the best doctors and hospitals in the state. We review Primary Care Provider (PCP) medical records periodically for compliance with standard medical record-keeping, documentation and standard medical practices.

Pharmacy Network—Prescriptions filled by QualChoice members at Optum-participating pharmacies are screened for safety and appropriateness. Factors considered include: drug-age conflict, drug-drug interaction, drug-pregnancy conflict, drug-disease conflict, late refill, refill too soon, therapeutic duplication, low daily dose, excessive use and high daily dose.

Organizational Collaboration—QualChoice collaborates with national organizations aimed at increasing patient safety, including: