For most covered services, there’s no paperwork to fill out. Just show your QualChoice ID card and pay your plan’s cost share amount.
When you visit a doctor or healthcare facility, the medical provider will complete and submit the claim paperwork. If the provider cannot submit a claim, you may pay for the charges and be reimbursed (according to your benefit plan) by submitting a Medical Claim Form to QualChoice.
For out-of-network emergency care, you or your provider may file the Medical Claim Form.
QualChoice will send you an Explanation of Benefits showing the costs covered by your plan and the remaining charges that you must pay.
Note: If submitting the Medical Claim Form yourself, be sure to read the instructions on the back of the form carefully. To consider your claim for payment, we will need all the information requested. The form also lists documents that are not accepted and reasons why your claim may be rejected. Be sure to keep a copy for your records.
Download a Medical Claim Form.
For questions or help, call Customer Service at 501.228.7111 or 1.800.235.7111.
