QualChoice Health Insurance                                                      June 04, 2015
Quality Results QualChoice Provider Newsletter
QualChoice & Industry News
ICD-10 Transition
 
For the past 30 years, ICD-9 has been the code set used to report diagnoses and procedures in administrative transactions. The Department of Health and Human Services (HHS) is now requirinq replacement of ICD-9 with the ICD-10 code set. All HIPAA-covered medical service providers sending claims to QualChoice must begin using the ICD-10 code sets on October 1, 2015. Read more

New Provider Log-In Credentials

The QualChoice provider portal offers secure online access for healthcare providers to handle daily business transactions. The portal is governed by a strict access policy to make sure that no PHI is inappropriately distributed.

 

Starting August 1, 2015, each individual user in any provider office, group or facility using the QualChoice web portal must have a separate secure account. Read more.


PCP Alignment Initiative
 

QualChoice will soon begin attributing members to a Primary Care Physician (PCP). A PCP can make sure that members get the preventive care they need, as well as help them manage chronic illness. We support programs that pay PCPs incentives for appropriately managing patient care. We also provide reports to help physicians identify care gaps and possible interventions for population management. Read more.


Alerts & Reminders
Pre-Authorization Reminder
 

It is the responsibility of clinical members of your team to make medical determinations by reviewing the current QualChoice pre-authorization list and any applicable medical polices. These can be found online at QualChoice.com.


Be Sure to Use In-Network Services
 

Referring patients to out-of-network laboratory or pathology groups violates your provider's agreement with QualChoice, and causes patients to pay significantly more for these services. When services are not available through an in-network provider, participating providers must contact Care Management at 800.235.7111, ext. 7014 to submit an Out-of-Network Authorization Request Form. Read more.


Your Provider Relations Representatives
 

Call your Provider Relations Representatives for any questions, Monday-Friday, 8:00 a.m. to 5:00 p.m. (CST). Read more.


Remember to Use Current QualChoice Forms
 

Please check the Provider Forms & Information page at QualChoice.com frequently for the most current forms.


 

New or Revised Forms
Medical Policy Review
  


Provider Network Territory Map 

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

 


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