Working Together to Improve Healthcare
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Working Together to Improve Healthcare

We are proud to recognize the medical providers who had outstanding performances in the QualChoice 2018 value-based care programs. Thank you for helping improve healthcare for our members!

Progress in Primary Care Delivery Models
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Progress in Primary Care Delivery Models

The CPC+* and PCMH** value-based care programs were designed to test improved provider payment and service delivery models. The goals are better care for patients, smarter spending and healthier communities.

Change in ACH Provider Payment System
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Change in ACH Provider Payment System

Providers: Effective July 1, ACH payments and the corresponding 835 remittances will no longer be distributed through Optum Bank.

Risk Adjustment Data Validation Audit
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Risk Adjustment Data Validation Audit

HHS has recently initiated audits of health plans subject to risk adjustment under the Affordable Care Act (ACA). QualChoice is included in this audit and we, along with our contracted providers, are required to fully comply.

Value-Based Care Programs 2018 Year End
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Value-Based Care Programs 2018 Year End

Thank you to CPC+* and PCMH** program participating providers for working with us to improve healthcare! Please review these reminders as we prepare to wrap up another successful program year.

Winner of Flu Shot $1000 Prize Drawing
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Winner of Flu Shot $1000 Prize Drawing

Jimmy Dean, an employee of QualChoice customer Dreamline Manufacturing in Cabot, was presented with a check for $1000 by Martha Borders, QualChoice Sr. Account Service Representative.

Requests for Urgent or Expedited Pre-authorization
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Requests for Urgent or Expedited Pre-authorization

PROVIDERS: For urgent or expedited pre-authorizations, please use the Pre-authorization Request Form—Clinically Urgent or Expedited, found at QualChoice.com. The patient must be in an urgent condition when using this form to request pre-authorization of services.

Winner of First Flu Shot Prize Drawing
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Winner of First Flu Shot Prize Drawing

Logan Hoskins, an employee of QualChoice customer Adventure Subaru in Fayetteville, was presented with a check for $2000 by Bonnie Pruett, QualChoice Regional Sales Manager.

Value-Based Care Program Updates
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Value-Based Care Program Updates

Thank you to our CPC+ and PCMH program participating providers for helping us improve healthcare! Please review these updates to the programs.

Coverage UDPATE—Mental Health and Substance Use Disorder
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Coverage UDPATE—Mental Health and Substance Use Disorder

MEDICAL PROVIDERS: Please review these updated guidelines for our Outpatient Therapy for Mental Health & Substance Use Disorder medical coverage policy (BI273).