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ANNOUNCEMENTS

eQHealth Solutions Customer Service:

Monday - Friday (except Florida state recognized holidays)
8:00am - 5:00pm (EST)
Phone: 855-444-3747 
Phone: 85
5-440-3747


Attention DME Providers
If you are entering a DME request please make sure you are referencing the Florida Medicaid Fee Schedule for Prior Authorization Requirements.  If you do not have a copy of the Fee Schedule you can find them on our website on the following link.  
Florida DME Fee Schedule

Prior Authorization numbers
When referencing the Fee Schedule if the code you are requesting has a “PA” this means the code requires prior authorization and once approved you will receive your authorization letter with a PA#. 

If the code you are requesting only states “Medical Necessity” this means the code requires prior authorization however it does not require a PA #.  This means a PA# will NOT generate when you receive your authorization letter.  To avoid a denial on your claims make sure to include your authorization letter with your claim submission.

Submission Requirements for ADI and Outpatient Services

Untimely Authorization Requests
We wanted to remind you that all imaging and outpatient requests are required to be submitted as Prior Authorization.  Until current we have been allowing and reviewing these cases.  However, please refer to AHCA’s Authorization Requirements Coverage Policy. The only time Retrospective requests will be permissible is if the recipient has Retroactive Medicaid eligibility or as specified in the policy.  Please note as of June 19th, 2017 we will be enforcing this policy and any cases with dates that have been submitted untimely will be cancelled


Pended Reviews
We have recently seen an increase in “Pended” authorization requests for ADI.  The current Coverage policy for ADI does not list specific documentation criteria.  However AHCA’s Authorization Requirements Policy has specific criteria that we will be enforcing effective immediately. Authorization Requirements Coverage Policy

To avoid a denial of your imaging request, please make sure to follow the submission requirements located under page 2 section 2.4 Submission Requirements.  Failure to follow the stated requirements may result in denial of your request.

Please make sure everyone within your organization who submits authorization requests are aware of these requirements.




    
eQSuite


eQSuite Login

eQSuite is our proprietary web-based, HIPAA compliant prior authorization system which offers providers 24/7 accessibility to the information they need.


Provider Alerts

The Florida Medicaid program has an email alert system that providers can utilize to receive updates on health care information. To register please click on the below link.

FL Medicaid Health Care Alerts






 

 

 

 

 

 



 

 

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eQHealth Solutions - Florida Division

The Agency for Health Care Administration (Agency)  entered into a contract with eQHealth Solutions, Inc.  for utilization management, including prior authorization of the following Medicaid services: 

    Inpatient Medical and Surgical Services
    Personal Care Services
    PAC Waiver Services
    Advanced Diagnostic Imaging (ADI)
    Home Health Services 
    Prescribed Pediatric Extended Care (PPEC) Services
    Therapy Services 
    Durable Medical Equipment (DME)
    Dental Services
    Multi-Specialty Services

 eQHealth Solutions, Inc. is a non-profit health care quality improvement, utilization management and health information technology organization, providing a wide range of efficient and effective solutions to our clients.  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 is a market leader in assisting health care providers to adopt  information technology services to improve the quality of care offered to their patients.

  
 
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