Online Pre-authorizations Coming Soon!
We are proud to announce that we will soon launch a convenient new online pre-authorization tool. Automated pre-authorization via the MCG Cite AutoAuth module will be accessible through the My Account provider portal at QualChoice.com.
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
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
The Comprehensive Primary Care Plus (CPC+) program is under way! Rosters of participating providers may be accessed through the My Account portal.
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.