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How We Make Coverage Decisions
We work to make sure our members get the right healthcare in every care setting. We support proper care decisions based on medical necessity and the member’s specific health plan. When a service needs pre-authorization, our Medical Director and clinical staff follow QualChoice Medical Coverage Policies. They also follow the peer-reviewed and nationally noted guidelines of MCG Health, LLC.
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Employer Group Email: Demographic Verification
QualChoice sends member lists each year to the Internal Revenue Service (IRS) as proof of members’ health coverage. If member records do not match IRS records, QualChoice has 30 days to submit the correct data to the IRS.
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Transition Policy Extended for Non-ACA Compliant Plans
The Centers for Medicare and Medicaid Services (CMS) recently extended an existing transition policy for non-ACA compliant plans through the end of 2018.
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Amended Medical Coverage Policy
Preventive health benefit BI062 has been updated to allow virtual colonoscopy with pre-authorization. Added that Cologuard and Epi proColon tests will not be covered.
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Health Coverage and Your Taxes
The Affordable Care Act (ACA) requires everyone to have health insurance. You must report it on your 2016 federal tax return.
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Heart Health & QCARE
February is American Heart Month, the national awareness campaign aimed at preventing cardiovascular disease. If your plan includes QCARE, your employees have access to our Heart Health program, with nationally accepted practices and personal support for hypertension (high blood pressure).
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Employee Group Size Now Determined by ATNE
To meet compliance regulations, the employer group's Average Total Number of Employees (ATNE) is required.The ATNE is defined as: the sum of the number of employees on the last day of each month in
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November is American Diabetes Month
Diabetes is one of the leading causes of disability and death in the United States. One American in 11 has diabetes --- that's more than 29 million people.
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October is Cyber Security Awareness Month
These "security lessons learned" are gleaned from Federal Trade Commission (FTC) cases and may help improve your company's security practices:
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NEW! My Account Broker and Employer Pages
Our new My Account employer/broker pages at Qualchoice.com are now easier to use. And they're mobile-friendly, so you can manage your account on the go!
