Quality Results

An e-newsletter for doctors, other health care experts and facilities affiliated with QCA Health Plan, Inc., and QualChoice Life and Health Insurance Company, Inc.

Quality Results

2021

Summer 2021

  • Updated Telehealth & Virtual Services Guide
  • COVID Update Effective June 1, 2021
  • Updated MCG Guidelines
  • Providing Quality Care
  • Updated Provider Manual
  • Medical Coverage Policies Updates

Spring 2021

  • COVID Waiver Updates
  • Upcoming Changes to Clinical Editing Rules
  • High Tech Imaging Change
  • Lawrence Health Hospital Services Pre-authorization List
  • Avoid Imaging for Lower Back Pain
  • Medical Coverage Policies Updates

2020

Winter 2020

  • New Requirements for Availity 270/271 Eligibility Request
  • CMS Guidance on COVID-19 Vaccine Coverage
  • Coverage for COVID-19 Acute Transfers
  • Members to Receive New ID Cards
  • New Drug Formularies
  • Medical Coverage Policies Updates

Fall 2020

  • Practices Awarded Performance Payments
  • Flu Immunizations
  • Claims Timely Filing Requirements
  • Required Pre-Authorizations
  • COVID-19 Coverage
  • Coming Soon: Eligibility Verification Change
  • NovaSys Network Transition
  • New Office Location
  • Inpatient Antibiotic Prescribing
  • Medical Coverage Policies Updates

Summer 2020

  • Eligibility Verification Change
  • COVID-19 Coverage Update
  • QualChoice Telehealth Services
  • Value-Based Care Programs Performance Data
  • Antibiotic Prescribing for Children
  • We're Moving!
  • Medical Coverage Policies Updates

Spring 2020

  • COVID-19 Coverage Updates
  • Telehealth Services During COVID-19 Outbreak
  • Centene Announces Provider Support Program
  • Network Change
  • Helping Our Members Quit Tobacco and Nicotine
  • Antibiotic Prescribing and Use for Outpatients
  • Medical Coverage Policies Updates

2019

Winter 2019–2020

  • QualChoice Individual Plans ONLY Transferred to Ambetter
  • Two New Services Added to AutoAuth
  • New Change Healthcare/ECHO Health URL
  • Value-Based Care Programs Quality Data
  • Medical Record Review—HEDIS 2019 Data
  • Medical Coverage Policies Updates

Fall 2019

  • QualChoice Exchange Members Moving to Ambetter
  • CPC+, PCMH Performance Payments
  • AMS Conferences
  • Fetal/Genetic/Genomic Testing
  • Wellness Appointment Outreach
  • Medical Coverage Policies Updates

Summer 2019

  • New QualChoice Ownership
  • Change in ACH Payment System
  • Risk Adjustment Data Validation Audit
  • Requests for Urgent or Expedited Pre-authorization
  • 2018-2019 Flu Shot Campaign Successful
  • Keeping the Quality in QualChoice
  • Medical Coverage Policies Updates

Spring 2019

  • High-Tech Imaging Pre-auth and Appeals
  • Coverage UPDATE: Mental Health and Substance Use Disorder (BI273)
  • Transitional Care Management Services
  • Member Termination Policy Update
  • HEDIS Medical Records Review
  • It Pays to Use AutoAuth!
  • Members Can Win Cash by Getting a Flu Shot
  • Medical Coverage Policies Updates

Provider Quick Alert

2021

2020

2019

CPC+ QuickNews

2021

2020

2019