QualChoice is required by the Centers for Medicare & Medicaid Services (CMS) to submit complete diagnostic data regarding members enrolled in our individual and small group metallic health plans.
As a valued part of our provider network, your cooperation and support in facilitating a medical record review is key to gathering this information.
We have partnered with Change Healthcare, Datafied, and Ciox® to conduct the medical chart review. A representative from one of these vendors will work with you to provide retrieval options and a list of the requested members’ medical records.
QualChoice now offers a bidirectional feed into your Electronic Medical Record (EMR) to help increase efficiency and accuracy in closing care gaps. If you are currently using Healow, Epic, Meditech, Oracle Cerner®, or Veradigm® (formerly Allscripts), email our risk adjustment team at RiskAdjustment@ARHealthWellness.com for details about this new tool. You can also contact them for information about our other programs, as well as questions about ICD-10 coding and documentation.