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.
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.
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.