While QualChoice does not require referrals, some services require pre-authorization (pre-approval). Find out ahead of time if the services you need call for a pre-auth. Your claim could be denied if pre-authorization was needed and you didn’t get it before you received care.
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.
As a QualChoice member, you will receive an EOB every 14 days if you have had any claims during that time. Review the EOB closely and compare it to the receipt or statement from your doctor.* Keep it for your records, along with your medical bills..
At QualChoice, our goal is to make health insurance simple and to make healthcare better. We’re working with providers, payers and state and federal groups to move from volume-based to value-based care.