QualityPath^®

Our QualityPath initiative identifies doctors, hospitals, and clinics that provide high-quality care at a lower bundled price for services, meaning reduced out-of-pocket costs for you and your family.

Health Care Made Simple:

How You Benefit from QualityPath

Higher-Quality Care: QualityPath requires providers to take steps that lead to better patient results
Cost Savings: Reduced out-of-pocket costs for you and your family
Test Warranty: The warranty covers the need for repeating the same scan due to quality issues.
Better Patient Experience: With QualityPath, you have less paperwork.

QualityPath for Tests:

CTs, MRIs, and Colonoscopies

Serious Savings on Tests with QualityPath

Both CTs and MRIs are covered at 100% for patients enrolled in a traditional health plan. If a repeat scan is required due to poor quality, the 30-day warranty covers the cost of the second scan at 100 percent if performed by the same QualityPath provider. Coverage levels may vary by employer.

QualityPath covers colonoscopies that:

Are done on adults
Screen for or are related to colorectal cancer screening

You must use both a doctor and a clinic or hospital that offer QualityPath colonoscopies.

When Do You Plan to Use QualityPath?

To enjoy the full benefits of QualityPath, call our Patient Experience Manager at 800.223.4139 x6607 before or shortly after you’ve scheduled your test.

For CTs and MRIs, you’ll still get QualityPath’s lower price if you forget to contact us;
you may, however, miss out on other benefits
For colonoscopies, you must contact us to experience any QualityPath benefits

Benefit Details: CTs and MRIs

Notification requirements:

Notification is not required to receive QualityPath benefit levels for CTs and MRIs.

Services covered at QualityPath level of benefits:
- Services performed by the QualityPath provider during the patient medical service encounter, including but not limited to:
  - The CT or MRI and related services on a non-emergent, outpatient basis. The image must be the primary purpose for the encounter. (See the section “Triggering Service Codes” below for the list of eligible non-emergent outpatient CTs and MRIs.)
  - Drugs, biologicals, and radiopharmaceuticals that function as supplies and contrast agents and are administered by the QualityPath provider
  - All supplies
  - Ancillary services performed by the QualityPath provider
  - Guidance service
  - Image processing services
  - Observation services
  - Image reading and interpretation
Warranty:

Services under the warranty are covered under the QualityPath level of benefits. The warranty period begins the day of the scan and covers the following:
- Reimaging, due to image quality, of the same site of service Triggering Service Code within 30-days when both episodes are provided by the same QualityPath designated provider.
Patient requirements to maintain the warranty include:
- Receiving all reimaging from the QualityPath provider.
- Contact the Patient Experience Manager at The Alliance 800.223.4139 x6607 if your doctor asks for the scan to be redone because of the quality.
Exclusions:

The following services are not eligible for the QualityPath level of benefits. Check with your benefits administrator for coverage levels under the standard health plan benefits.
- Emergent or inpatient care
- When the image is performed as part of a surgical procedure or other more comprehensive service
- Certain Specialized Imaging—those that may require special equipment in addition to CT/MRI machine, including:
  - Breast MRI
  - Cardiac MRI
  - Cardiac CT
- All services provided by a non-QualityPath provider including but not limited to the administration of contrast materials.
- Services provided by a QualityPath provider performed prior to member’s enrollment in the program
Triggering Service Codes:
- Download CT and MRI trigger codes.

Benefit Details: Colonoscopies

Notification requirements:

You must notify The Alliance before your colonoscopy appointment for you to receive the QualityPath level of benefits by calling The Alliance Patient Experience Manager at 800.223.4139 x6607. (Call us if you have questions or if you need help scheduling your appointment.)

You must notify The Alliance before your pre-operative visit for it to be covered at QualityPath level of benefits. (Note – most patients are not required by the colonoscopy provider to have a pre-operative visit.)

Services covered at the QualityPath level of benefits:

Pre-operative visit
Facility (clinic or hospital) charge
Surgeon’s fee
Anesthesia
Pathology
Post-procedure care from the surgeon for up to 7 days after the procedure, including:
- Follow-up visits
- Pain management

NOTE: please see warranty for information regarding complications.

Warranty:

The Alliance must be notified of possible warranty services no later than 14 days after the date of the colonoscopy. Call 800.223.4139 x6607 if you have services that may apply to the warranty.

Services under the warranty are covered under the QualityPath level of benefits. The warranty covers the following care related to the QualityPath colonoscopy:

Incomplete procedures including those halted due to poor preparation.
Emergent, urgent or inpatient care for up to 7 days following original procedure for gastrointestinal bleeding, abdominal pain and perforation.

Exclusions:

The following services are not eligible for the QualityPath level of benefits. Check with your benefits administrator for coverage levels under the standard health plan benefits.

Pre-operative lab work
Prep medications
Inpatient or emergency colonoscopies
Pediatric colonoscopies
Colonoscopies performed for reasons other than colorectal cancer screening or surveillance
Colonoscopies that are not the primary purpose of the visit
All services provided by a non-QualityPath provider
Post-procedure care that:
- is unrelated to the colonoscopy
- is not covered by the warranty
- occurs more than 7 days after the colonoscopy
Pre-op visits or colonoscopies performed prior to The Alliance receiving notification of the appointments.