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.

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.

QCA Health Plan, Inc. (QCA) and QualChoice Life and Health Insurance Company, Inc. (QCLH) currently hold NCQA Interim Health Plan Accreditation. The accreditation includes Commercial-HMO and Exchange-HMO (QCA) as well as Exchange-PPO (QCLH) product lines. The interim accreditation is effective as of April 24, 2020 and expires on October 24, 2021.

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

Improving Quality of Care and Patient Safety through Partnerships

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: