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.