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A wide and diverse network of
healthcare professionals.

New for 2017: PCP Required for Individual Plan Members

Beginning January 1, 2017, QualChoice individual metallic plan (Bronze, Silver, Gold, Platinum and Catastrophic) members will be in the Select network and will be required to choose a PCP. These members will have a unique QualChoice card to help you identify them. 

Members who do not choose a provider will be assigned one. Rosters of newly assigned members will be available through My Account* under the Provider Reports tab. Learn more.

HEDIS Medical Record Review

QualChoice is compiling data on 2016 clinical outcomes for Healthcare Effectiveness Data and Information Set (HEDIS) standards. Beginning in February, Advantmed, a medical record retrieval company, will contact your office by fax and phone to collect medical records on our behalf.

For questions or concerns about the HEDIS data collection, please contact your QualChoice Provider Relations Representative.

CPC+ Update

The Centers for Medicare & Medicaid Services (CMS) has announced the practices selected for the Comprehensive Primary Care Plus (CPC+) model. QualChoice will be reaching out to those practices to secure contract amendments. 

CPC+ integrates many features of the original CPC initiative, including practice readiness, aligned payment reform, actionable performance-based incentives, robust data sharing and an innovative payment structure. 

Welcome Providers & Administrators

We value our healthcare providers and the care they bring to our members. Registered providers may log in to conduct many QualChoice transactions conveniently and securely online.

Resources & Tools

Provider Communications

Quality Results

This quarterly electronic newsletter provides comprehensive news and information to make working with QualChoice easy for you.

Provider Action Alerts

Time-sensitive administrative and billing updates, medical policy revisions, etc. delivered electronically.

Partner with QualChoice

Call or email to join our network or to find out more information about physician and facility credentialing.

800.235.7111 or 501.228.7111, ext. 7004

Download PDFProvider Relations Representatives

Our Paperless Initiative

QualChoice is working to reduce our impact on the environment. As part of our paperless initiative, enrollment in Electronic Funds Transfer (EFT) is required for participating providers.

Enroll today through Alegeus Technologies


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