Attention All Hospital Providers:
As part of eQHealth Solutions’ contract with the Florida Agency for Health Care Administration (the Agency), eQHealth Solutions is required to annually review the utilization plans for all Medicaid participating hospitals to ensure compliance with the Code of Federal Regulations Title 42 Part 456 (Utilization Control §456.60–§456.145). Please be aware that hospitals must adhere to the submission timelines provided by eQHealth Solutions, which reflect the Agency’s guidelines.
• ALL 2019 UR PLANS MUST BE SUBMITTED NO LATER THAN JUNE 15th, 2019.
•INCLUDE YOUR MEDICAID PROVIDER ID # ON YOUR PLAN AND ALL HOSPITALS YOUR ID# COVERS.
•INCLUDE A CONTACT PERSON WITH THEIR EMAIL AND A PHONE NUMBER SHOULD WE HAVE ANY QUESTIONS.
We will review your submission, suggest any recommendations if needed and respond back with the results. If recommendations are made you will be afforded the opportunity to make any changes or corrections and resend the UR PLAN back in for review, the corrections must be received prior to the deadline.
Provider Alert from the Agency For Health Care Administration:
Important Upcoming Policy Change Reminder: New and Enhanced Self-Service Web Portal Features FL Medicaid Policy Change Reminder (Click Here)
Attention Dental Providers:
Dental Services has transitioned to SMMC Dental Program, effective 2/1/19. For additional information, please visit the Agency’s website for information on Florida Medicaid’s Dental Changes : FL Medicaid Dental Announcement
Behavior Analysis Providers:
Untimely Authorization Requests:
This is a reminder that Behavior Analysis Services are to be submitted as Prior Authorization. Any cases submitted for dates of service that are not current are considered untimely and will be cancelled. Please refer to our Phase 2 Provider Training, Page 40 and 43. You can also refer to AHCA’s Authorization Requirements Coverage Policy Bullet 2.0 via the following link FL Medicaid Authorization Requirements Policy Retrospective requests will be permissible if the recipient has Retroactive Medicaid eligibility or as specified in the policy.
2.0 Authorization Requirements
2.1 When to Request Authorization
- Providers must obtain authorization prior to rendering Florida Medicaid-covered services, except in an emergency, when:
- Specified in the service-specific coverage policy or the applicable Florida Medicaid fee schedule(s).
- Services will be performed out-of-state.
Thank you in advance for your cooperation.