QualChoice Health Insurance                                                                 July 10, 2014
Quality Results QualChoice Provider Newsletter
QualChoice & Industry News
QualChoice Now Part of CHI
We are pleased to announce that Catholic Health Initiatives (CHI) has acquired controlling shares in our parent company, QualChoice Holdings, Inc. We are proud that this national healthcare leader has chosen to partner with us. We're excited about what the investment will mean for our members, healthcare providers and brokers.
 
At this time, we expect no major changes in our operations or provider network. If you have any questions or concerns about the change, please call Customer Service at 800.235.7111 or 501.228.7111.
 
Sincerely,
 
Mike Stock
CEO and President
 
Click here to read the QualChoice/CHI press release.
In Memoriam
Dr. Richard Armstrong, MD, Vice President of Medical Affairs
We are saddened by the recent loss of Dr. Richard Armstrong on June 9, 2014. Affectionately called "Dr. A", Richard joined QualChoice in 2002 as a Medical Director. He was promoted to Vice-President of Medical Affairs in 2010, bringing over 35 years of experience in the healthcare industry to that position. He was a great colleague and friend to many of us and will be deeply missed.

Alerts & Reminders
ACA Requirements Affect Coding
Two effects of the Affordable Care Act are a growing focus on regular comprehensive patient evaluation/documentation and an increased involvement in member engagement/care planning. Both depend on accurate and complete diagnostic coding. Here are some tips.
 
New ID Cards
Effective July 1, 2014, QualChoice members have a new 'travel network', or primary network if the member lives outside of the QualChoice network.Replacement ID cards with new network logos and contact information have been mailed to members. Please check cards carefully to make sure services are covered in-network. View card examples.
 
High Value Networks
QualChoice High Value Networks are smaller, geographically targeted networks. They do not include all providers in our statewide network. This allows us to offer our members a lower-cost plan. Read more.
 
Closing Your Practice or Adding a Location?
If you have any important changes that will affect your status as a network provider, it's important for us to know - especially if you're closing your practice. Please complete and submit the Provider Information Change Form (formerly Demographic Change Form).
 
ARBenefits Silver Plan News
Oncology Pre-Notification
Effective July 1, 2014, do not forget to notify American Health Holdings (AHH) with newly diagnosed oncology patients.
 
New Pre-Auth Requirements for Specialty Medications
Effective September 1, 2014, ARBenefits will require pre-authorization of defined specialty medications administered on or after that date. To pre-authorize specialty drugs, call EBRx at 866.564.8258.
 
Covered Wellness Screenings
QualChoice follows the United States Preventive Services Task Force (USPSTF) List A and List B recommendations for patient wellness. Many tests that physicians perform during a wellness exam are not included in the "no cost wellness exam" that is covered by insurance. Two examples are CBC and urinalysis. Read more.
 
Remember to Use Current QualChoice Forms
Check the Provider Forms & Information page frequently for the most current forms. See new or revised forms.
 
Claims Corner
ClaimCheck Plus Modifier
Please make sure all modifiers are valid. If the modifier is not correct, the claim will be denied. Read more.
 
Medical Policy Review

Provider Network Territory Map 

Find your QualChoice Provider Representative 
and their contact information by viewing the 

 


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