eQHealth Solutions Customer Service:
Monday - Friday (except Florida state recognized holidays)
8:00am - 5:00pm (EST)
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
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.