How We Make Coverage Decisions
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How We Make Coverage Decisions

We work to make sure our members get the right healthcare in every care setting. We support proper care decisions based on medical necessity and the member’s specific health plan. When a service needs pre-authorization, our Medical Director and clinical staff follow QualChoice Medical Coverage Policies. They also follow the peer-reviewed and nationally noted guidelines of MCG Health, LLC.

New for 2017: PCP Required for Individual Plan Members
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New for 2017: PCP Required for Individual Plan Members

Beginning January 1, 2017, QualChoice individual metallic plan (Bronze, Silver, Gold, Platinum and Catastrophic) members, as well as those with insurance through HealthCare.gov or Arkansas Works will be in the Select network...

CPC+ Takes Off
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CPC+ Takes Off

The Comprehensive Primary Care Plus (CPC+) program is under way! Rosters of participating providers may be accessed through the My Account portal.

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Medical Record Review for HEDIS Reporting

We are compiling data on 2016 clinical outcomes for Healthcare Effectiveness Data and Information Set (HEDIS) standards, which are designed to help consumers compare performance across plans.