Prior Authorization Template and Instructions. Ability to document and track peer-to-peer conversations, reconsideration reviews and multi-level appeal processes. The LSU First Health Plan is a self-insured plan. Prior Authorization. Forms Hospital Contact Form . Please include any addtl dx codes in . PDF ALL REQUIRED FIELDS MUST BE FILLED IN ... - Home State Health PDF USFHP updated PA Form w address 1.19.21 updated PDF Prior Authorization of Elective Procedures For more information on our Population Health Management Solutions, please visit us at www.eqhs.org. Fill out the form here Precertification for Advanced Imaging providers: (Toll Free): 888-204-0502. eQHealth Solutions Governance. Corporate Headquarters. This page is used to inform website visitors regarding our policies with the collection, use, and disclosure of electronic Protected Health Information (ePHI) if anyone decided to use our Service, the eQSuite | Care Coordination website. PRIOR AUTH IMPORTANT: The grace period for late requests is over. The Prior Authorization Template is optional, hospitals are not required to submit the form to . The prior authorization submission instructions for HPE are available by going to www.ctdssmap.com and selecting Information>Publications, and then scrolling down to Chapter 9 Prior Authorization>Section 9.2>page 10 The following providers or services have Prior Authorization requirements: • Durable Medical Equipment (DME)* This is not an inpatient admission (concurrent) review. eQReview. Multi-faceted ability to receive UM requests via web-based entry on a provider portal, call center and/or fax submission and tracking. New in 2020 Prior Authorization with eQHealth System access control for changing authorized users. Provider Notice Issued 01/10/2020 | HFS Medical Necessity Review/Prior Authorization Request Form Fax: 866-337-8690 Mail: eQHealth Solutions 1431 Greenway Drive Suite 500 Irving, TX 75038 Page 1 of 2 Effective: 12/05/2019 Version: 12/04/2019 **PLEASE PRINT** **PLEASE PRINT** Home; Provider Resources. If you choose to use our Service, then you agree to safegard ePHI in relation with this policy. Baton Rouge, LA 70809. eQHealth Solutions, the QIO-like organization for the Arkansas Department of Human Services (DHS), provides utilization and quality control peer review for outpatient behavioral health services to qualifying Arkansas Medicaid beneficiaries. Learn more about. o If the request is approved, the approval is valid for a 60-day period from the date of the QIO's PRIOR AUTH IMPORTANT: The grace period for late requests is over. They certify pre-authorizations and proactively reach out to members with specific health care risks. PDF INDICATES REQUIRED FIELD *1599* - Home State Health The Agency for Health Care Administration has contracted with a certified Quality Improvement Organization (QIO), eQHealth Solutions, Inc. to provide medical necessity reviews for Medicaid home health services. ABS partners with eQHealth Solutions to provide utilization management for all services that require prior authorization. … health care need that necessitates skilled Home Health care. Population Health Management Software | eQHealth Solutions Select the resource you need by clicking the topic on the left. Behavior Analysis Providers: This is a reminder that according to Behavior Analysis Services Coverage Policy (7.2), BA services require prior authorization before they . This is not an inpatient admission (concurrent) review. ADX Reminder: ADX CODE: The admit dx code field requires all digits and no decimal. Individual Provider Training Request Form. Together, eQHealth and HCPF will serve Medicaid members by focusing on and implementing HCPF's mission to improve health care access and outcomes for the people we serve . How To Guides; Register for a webinar; Archived Bulletins; Behavior Analysis. eQHealth Solutions, established in 1986, is a population health management and healthcare IT solutions company that touches millions of lives every year. Here you will find links to the Log in for eQSuite, to the Mississippi Division of Medicaid and to Conduent web sites. You are not logged in or your session has expired. The Illinois Department of Healthcare and Family Services (HFS), in conjunction with its Quality Improvement Organization, eQHealth Solutions (eQHealth), has created a new process to allow hospitals to submit inpatient concurrent review requests for MANG Pended patients. The Prior Approval Unit handles durable medical equipment, therapeutic supplies, mobility devices, therapies, home health, and bariatric surgery request for the Illinois Department of Health Care & Family Services. Prior authorization, concurrent, and retrospective reviews. Alliant Health Solutions performs medical review or prior authorization certification for the following: Cardiac Rehabilitation Services Certain Community Mental Health Services . eQ Health Difference CMS Certified Care Management High-Tech & High-Touch Solutions End-to-End Clinical Integration HITRUST Certified Testimonials Awards Insights Blog In The News Events Resources Webinars/Videos-On-Demand Podcast About Us History Leadership Locations Careers Partners Affiliates . In the menu above, there are links to eQHealth Solutions Education resources, Contact information, the Advanced Imaging Provider Manual and forms, and Reconsideration Information. eQ Health Solutions provides Medical Management and Care Coordination. PSYCH Review: No Axis grids I-V to fill out! eQHealth Solutions is pleased to be selected by the Colorado Department of Health Care Policy and Financing (HCPF) to provide services for the ColoradoPAR (prior authorization request) program, effective September 1, 2015. They certify pre-authorizations and proactively reach out to members with specific health care risks. WebTPA provides medical claim administration. Prior Authorizations. All reviews will be conducted by a licensed speech, occupational or physical therapist depending on the type of service under review. Better manage expenses by improving utilization review, utilization management and prior authorization. Secure transmission protocols - encryption of all data transfers. They have a dedicated team of employees to answer calls and process claims. Prior Authorization Request Form Fax to 586-693-4829 Effective: 01/01/2020 Version: 12/10/2019 Page 1 of 2 Please be aware that you may submit all inquiries for prior authorization requests via the eQSuite® Provider Portal at User Name: * EQ-PAF-1599 *1599* Request for additional units. EQ Health Prior Authorization Change Request Form - Confidential Prior Authorization FAX: 800-922-3508 Kepro Customer Service Phone: 720 -689-6340 Email: coproviderissue@kepro.com. Access Forms; Provider Manuals; Codes that require prior authorization (If the member is on a Health First Colorado Managed Care Program, prior … Out Of State -Authorization Request Form. All prior authorization reviews in process before Aug. 1 will be completed by eQHealth as part of the transition to Alliant. Behavioral Health. o If the request is approved, the approval is valid for a 60-day period from the date of the QIO's Effective August 1st we will not accept any Prior Auth request less than 3 business days prior to the procedure. Prior authorization is required regardless of reimbursement type (DRG or Per Diem). Existing Authorization Units *OUTPATIENT SERVICE TYPE (Enter the Service type number in the boxes) Behavioral Health. Prior authorization review is strictly for certification (prior authorization) of specific procedures. Click below for new copy of HFS Attachments A-F 12292020URUpdates . Better manage expenses by improving utilization review, utilization management and prior authorization. The Service Request Form is intended for providers to submit their patient's authorization requests to eQ Health for processing. Forgot Your Password? Forms Q14. Fax request form - Personal Care Service Providers. 528 BH Chemical Substance Abuse 529 BH Psychiatric Admission 531 BH Eating Disorders 532 BH Crisis Stabilization Unit 535 BH Residential Treatment - Substance Use 536 BH Residential Treatment - Mental Health. 533 BH Applied Behavioral Analysis 512 BH Community Based Services 515 BH Electroconvulsive Therapy 516 BH Intensive Outpatient Therapy 510 BH Medical Management Prior Authorization Resources Page. The Prior Authorization Template can be used by hospitals as a tool to gather all the pertinent clinical information from the attending (surgeon) physician prior to submitting a request via eQSuite™. Web Administrator Guide Acute Home Health services are allowed without prior authorization for up to 60 calendar days or until the acute condition is resolved, whichever comes first. 2021 Prior Authorization Updates New 2021 Prior . eQSuite® features include: Paperless workflow. eQHealth also provides utilization and quality control peer review for inpatient psychiatric services for Arkansas Medicaid beneficiaries underage of . Provider Notice Issued 01/10/2020. The health assessment will still be required for any rewards to be earned and annual physicals/well visits will only be rewarded for visits to Ascension Network (Tier 1) providers, the incentive amount is $125. If the primary dx code submitted for Prior Authorization review changes, do we need to contact eQHealth to change it on the review? eQHealth Fax Cover Sheet. Call us toll-free for business development, marketing and sales at 1-800-720-2578. The LSU First Health Plan is a self-insured plan. Suite 101. Prior Authorization Resources Page. eQHealth Solutions is a market leader in assisting health care providers to adopt information technology services . 8440 Jefferson Highway. Units What are Prior Authorizations? Watch your email in January for more about our 2021 Well-being Program. January 15, 2020. eQHealth Solutions is the new vendor partner that is providing utilization management services for Ascension SmartHealth beginning Jan. 1, 2020. eQHealth has a portal to submit prior authorization requests which allows for immediate authorization in certain cases when criteria is met based on clinical documentation provided. Induction of Labor - Clinical Considerations and Recommendations. Click HERE to LOGIN again. CDC+ Required Supporting Documentation. CDC+ Reconsideration Request. eQHealth Solutions is a population health management and IT solutions company that is accredited by URAC in Health Utilization Management and has more than 30 years of experience providing utilization management expertise in all 50 states. The form is designed to serve as a standardized prior authorization form accepted by multiple health plans. Wesley F. Prater, MD, Interim Medical Director. Call us toll-free for business development, marketing and sales at 1-800-720-2578. eQ Health Difference CMS Certified Care Management High-Tech & High-Touch Solutions End-to-End Clinical Integration HITRUST Certified Testimonials Awards Insights Blog In The News Events Resources Webinars/Videos-On-Demand Podcast About Us History Leadership Locations Careers Partners Affiliates . Fax: 601-352-6358. Fax request form - Non-Personal Care Providers. Reconsideration Review Request Form. Corporate Headquarters. They have a dedicated team of employees to answer calls and process claims. The department will use this page to communicate prior approval information to our providers. How To Guides; Register for a webinar; Archived Bulletins; Behavior Analysis. Please include any addtl dx codes in . As shared in Provider Bulletin 20-34 , Nebraska Medicaid now has a new Utilization Management Contractor, eQHealth Solutions.Below are resources for providers to get to know eQHealth Solutions: Available Training Sessions (through Oct 30); Training Videos: DHHS YouTube eQHealth Solutions will provide the following services to Medicaid providers: If prior authorization is needed for a certain service, your provider must get it before giving your child the service. INPATIENT PRIOR AUTHORIZATION FORM *INPATIENT SERVICE TYPE (Enter the Service type number in the boxes) Additional . Home; Provider Resources. Top 7 Provider Web Reports . Current CPT/HCPC Codes: Procedure Code and applicable modifier (s) Narrative Description . We ask that you update your records to reflect this change. If you choose to use our Service, then you agree to safegard ePHI in relation with this policy. Services include: prior authorization and utilization review, care coordination, quality improvement activities, medical record review, health and wellness, and quality review services for home and community based waiver programs. eQHealth Solutions 2050 - 10 Finley Road, Lombard, IL 60148 Business Phone: 630.317.5100 Business Fax: 630.317.5101 Review Certification Line: 800.418.4033 - Mon-Fri, 8:30 am to 5:00 pm, CST Prior authorization is when your provider gets approval from Molina Healthcare to provide you a service. information in one location. Glen J. Golemi President, Chief Executive Officer. Maternity & Newborn Authorization Requirements (After 7/1/13) Maternity & Newborn Authorization Requirements (Prior to 7/1/13) Out of state Authorization Process and Guidelines. Quick Resources. Suite 101. eQHealth Solutions 2050 - 10 Finley Road, Lombard, IL 60148 Business Phone: 630.317.5100 Business Fax: 630.317.5101 Review Certification Line: 800.418.4033 - Mon-Fri, 8:30 am to 5:00 pm, CST Access Forms; Provider Manuals; Codes that require prior authorization Baton Rouge, LA 70809. ADX Reminder: ADX CODE: The admit dx code field requires all digits and no decimal. CDC+ Parent or Legal Guardian Work Schedule. EQ Health Prior Authorization Change Request Form - Confidential Prior Authorization FAX: 800-922-3508 Kepro Customer Service Phone: 720-689-6340 Email: coproviderissue@kepro.com To request a change to a PAR originally completed by eQHealth, please complete this form and either fax to 800-922-3508, or securely email to coproviderissue@kepro.com. 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