Introduction

Thank you for becoming a participating provider with QualChoice! Since the administration of health care can be complicated, we've designed this manual to be a resource for providers, containing coverage guidelines to the most common procedures and policies. Questions? Please email us at pr@qualchoice.com or contact us at 501.228.7111 or 800.235.7111 and ask to speak to a Provider Relations Representative.

About Us

Learn more here.

Products and Services

Our goal is to simplify health insurance and improve the health of Arkansans, while providing reliable personal service. We work to create flexible benefit plans that balance today's distinct healthcare needs with today's economics. Our comprehensive provider networks complement our range of products to maximize member choice, value and security.

Group Medical Plans

Group Supplemental Coverage 

Administered by Superior Vision

Third Party Administration 

Administered by PrimePay

Individual and Family Plans

Commitment to Members and Providers

QualChoice is dedicated to taking care of Arkansans, which means we have a personal commitment to taking care of our members, providers and clients. In addition to helping finance the high cost of illness, we want to promote member health by focusing on preventive health screenings that can lead to early diagnosis and treatment.

Whether protecting your privacy/security, answering questions or processing claims quickly, we are committed to providing outstanding customer service. We value our provider network and work hard to give you the tools you need to better serve your patients. If you have any comments or suggestions about how we can better serve you, please email us at pr@qualchoice.com or call 501.228.7111 or 800.235.7111.

HIPAA and HITECH Compliance

As stated in the Provider Agreement, QualChoice and QCA Health Plan, Inc. are required to comply with various privacy and security standards imposed by law, including, but not limited to the following, as modified or supplemented by the HITECH Act and implementing regulations and guidance (collectively, "the Standards").

  • Standards for Privacy of Individually Identifiable Health Information (45 CFR Parts 160 and 164, as amended) (hereinafter the "Privacy Rule")
  • Standards for Electronic Transactions (45 CFR Parts 160 and 162) (hereinafter the "Transactions and Code Sets Rule")
  • Security Standards for the Protection of Electronic Protected Health Information (45 CFR Parts 160 and 164) (hereinafter the "Security Rule")

The HIPAA and HITECH Disclosure describes how QualChoice may collect, use and disclose Protected Health Information (PHI) and rights concerning PHI, as defined by HIPAA. PHI is information that can reasonably be used to identify an individual and that individual's past, present or future physical or mental health condition, the provision of health care, or the payment of health care.

Disclaimer

This Manual is a component of your QualChoice Provider Agreement and is meant to provide clarity and implementation guidance. In the event of a conflict or inconsistency between this Manual and your Agreement, the provisions of your Agreement will take precedence.

In the event of a conflict or inconsistency between state regulatory requirements and this Manual, the regulatory provisions will control, except when the benefit contracts fall outside the scope of that regulatory control.

QualChoice makes no representations or warranties with respect to the content hereof. Further, QualChoice reserves the right to revise this publication without obligation on our part to notify any person or entity of such revision or changes. Revisions are effective immediately upon publication.

Updates to any part of this Manual may be made by QualChoice at any time. QualChoice may give notice of such updates in a variety of ways, depending on the nature of the update, including issuance of a letter to providers, publication in Quality Results Providers’ newsletter, Provider Quick Alert or other publications of QualChoice, or posting to the QualChoice web site, www.qualchoice.com.

Special Note: This Manual is provided for the convenience of providers participating in any QualChoice network. Nothing in this Manual shall be interpreted as guaranteeing coverage of any service, treatment, drugs or supplies because coverage or non-coverage is always governed exclusively by the terms of the member’s health benefit coverage documents. Accordingly, in case of any question or doubt about coverage, providers should always review the member’s particular health benefit coverage document.

Any five-digit physician’s current procedural terminology (CPT) codes, descriptions, numeric modifiers, instructions, guidelines and other material are copyrighted by the American Medical Association. All Rights Reserved.

Unless otherwise indicated, any reference in this Manual to "company" or “us”, shall be deemed to refer to QualChoice.

The QualChoice Network Provider Agreement and the Provider Manual is between QCA Health Plan, Inc., and the Network Provider, a duly licensed provider in the state in which he/she practices. QualChoice Holdings, Inc. is the parent company of QCA Health Plan, Inc., and QualChoice Life and Health Insurance Company, Inc. (collectively ‘QualChoice‘).   

Other policies and procedures, not reflected in this Manual, are published regularly in our provider newsletter, Quality Results, in official plan documents, or in other special publications, letters, or notices, including but not limited to credentialing standards, appeals policies and procedures, network terms and conditions, and Provider Agreements. To ensure you have the most current information, please visit qualchoice.com or contact us Monday through Friday, 8:00 a.m. to 5:00 p.m. at 501.228.7111 or 800.235.7111 and ask to speak to a Provider Services Representative.