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ANNOUNCEMENTS

eQHealth Solutions Customer Service:

Monday - Friday (except Florida state recognized holidays)
8:00am - 5:00pm (ET)
855-444-3747 (toll free phone)
855-440-3747 (toll free fax)


Fair Hearing
As of March 1, 2017 The Fair Hearing Process has moved from being managed by DCF to now being managed by AHCA.  The letters from eQHealth will be updated with the new information by the first of April until that time please be notified that the contact information for Fair Hearing is as follows:

You may ask for a fair hearing by contacting AHCA by telephone at (877)-254-1055, by fax at (239)-338-2642, in writing at, Agency for Health Care Administration Medicaid Hearing Unit P.O Box 60127 Ft.Myers, FL 33906 or by email at MedicaidHearingUnit@ahca.myflorida.com


Hospital UR PLANS

The review process for 2017 UR PLANS has begun.  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.  Please note that the deadline for your submissions are May 31st 2017.  Any submissions received after the deadline will not be reviewed.  

If you have any additional questions please contact urplans@eqhs.org



PACWAIVER FAXED REQUESTS
Please note that as of April 10th, 2017, eQHealth Solutions will no longer be accepting faxed or emailed requests for PACWAIVER requests. These reviews will need to be entered in by your organization online via eQSuite.  


INPATIENT & IMAGING FAXED REQUESTS
Please note that on August 1st, 2016, eQHealth Solutions will no longer be accepting faxed in inpatient or advanced diagnostic imaging requests. These reviews will need to be entered in by your organization or the respective provider via eQSuite online. 


MULTISPECIALTY FAXED REQUESTS
Please note that as of October 15, 2016, eQHealth Solutions will no longer be accepting faxed in multispecialty requests. These reviews will need to be entered in by your organization or the respective provider via eQSuite online.  

If you would like assistance regarding entering in review requests via eQsuite, please refer to our online User Guide for assistance.  If you have questions, please contact Provider Outreach at PR@EQHS.ORG.


How To Enroll As A Provider To Submit Reviews Online Using eQSuite

1) Find and download the appropriate Contact Form below for your service type.

2) Fill out the contact form, making sure that it is legible and knowing that the system administrator will receive an email with the initial username and password once the Contact Form has been processed.You may fax, email or mail this form in. FAX 855- 440-3747 EMAIL: pr@eqhs.org

3) After receiving the email with the username and password, the system administrator will then have access to login and to submit requests online. The system administrator can then assign additional usernames and passwords to those under that provider Medicaid number assigned. For more information regarding the System Administrator, please see the link below.

4) If you need further assistance with the process, please call customer service at 855-444-3747 or EMAIL: pr@eqhs.org

Please  note that if you are submitting CDC+ reviews or Care Coordination requests, these are not currently submitted online and instead should either be faxed or mailed in. Authorization forms are under Forms and Downloads under each appropriate tab at the top. Thank you.


Statewide Inpatient Psychiatric Services (SIPP) Access Form

Dental Access Form

Diagnostic Imaging Access Form


DME Access Form

Home Health /PCS Access Form


Inpatient Access Form

Physician Access Form

PAC WAIVER Access form

Therapy Access Form

System Administrator Guide

    
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.

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 Advanced Diagnostic Imaging Requests (ADI)

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.


 





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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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