Working Together to Improve Healthcare

Welcome Providers & Administrators

We value our healthcare providers and the care they bring to our members. Registered providers may log in to conduct many QualChoice transactions conveniently and securely online.

CPC+ Takes Off

The Comprehensive Primary Care Plus (CPC+) program is under way! Rosters of participating providers may be accessed through the My Account portal. The first Care Management payment from QualChoice will be made in July. Review the CPC+ Participating Provider Training deck for an overview of the program, and find the answers to FAQs here. For more about CPC+, visit Centers for Medicare and Medicaid Services.

Medical Record Review for HEDIS Reporting

We are compiling data on 2016 clinical outcomes for Healthcare Effectiveness Data and Information Set (HEDIS) standards, which are designed to help consumers compare performance across plans. Data collection begins this month and continues until mid-May. Advantmed,a medical record retrieval company, will contact your office by fax and telephone to collect medical records on our behalf. Learn more about HEDIS and records collection.

New for 2017: PCP Required for Individual Plan Members

Beginning January 1, 2017, QualChoice individual metallic plan (Bronze, Silver, Gold, Platinum and Catastrophic) members, as well as those with insurance through HealthCare.gov or Arkansas Works will be in the Select network and will be required to choose a PCP. A unique QualChoice ID card will help you identify them. 

Members who do not choose a provider will be assigned one. Rosters of newly assigned members will be available through My Account* under the Provider Reports tab. Learn more.

Resources & Tools

Our Paperless Initiative

QualChoice is working to reduce our impact on the environment. As part of our paperless initiative, enrollment in Electronic Funds Transfer (EFT) is required for participating providers.

Enroll today through Alegeus Technologies

877.389.1160

 

Provider Communications

Quality Results

This quarterly electronic newsletter provides comprehensive news and information to make working with QualChoice easy for you.

Provider Action Alerts

Time-sensitive administrative and billing updates, medical policy revisions, etc. delivered electronically.

Partner with QualChoice

Call or email to join our network or to find out more information about physician and facility credentialing.

800.235.7111 or 501.228.7111, ext. 7004

providerrelations@qualchoice.com

 Provider Relations Representatives