Home
Provider Bulletins
How To Guides
Register for a webinar
Behavior Analysis
Access Forms
Provider Manuals
Codes that require prior authorization
Forms and Downloads
eQSuite User Guides
Education and Training Resources
Dental
Access Forms
Provider Manuals
Codes that require prior authorization
Forms and Downloads
eQSuite User Guides
Education and Training Resources
Multispecialty/ADI
Access Forms
Provider Manuals
Codes that require prior authorization
Forms and Downloads
eQSuite User Guides
Education and Training Resources
Therapy/DME
Access Forms
Provider Manuals
Codes that require prior authorization
Forms and Downloads
eQSuite User Guides
Education and Training Resources
Inpatient
Access Forms
Provider Manuals
Codes
UR PLANS
Forms and Downloads
eQSuite User Guides
Education and Training Resources
Home Health/PCS/PPEC
Access Forms
Provider Manuals
Codes that require prior authorization
Forms and Downloads
eQSuite User Guides
Education and Training Resources
Contact Us
About Us
Mission, Vision and Values
Management Team
Career Opportunities
Holiday Schedule
Physician Peer Reviewers
Home Health/PCS/PPEC
»
Forms and Downloads
Topics
Access Forms
Provider Manuals
Codes that require prior authorization
Forms and Downloads
eQSuite User Guides
Education and Training Resources
Links
Authorization for Private Duty Nursing by a Parent or Legal Guardian
Care Coordination Demographic Sheet
Care Coordination PPEC/PDN Request Fax Form~revised April 2014
Care Coordination PPEC/PDN Request Fax Form~writable~revised April 2014
Care Coordination Reconsideration Request Form~Updated April 2014
CDC Fax Cover Sheet~writable PDF~revised April 2014
CDC+ Fax Cover Sheet revised April 2014
CDC+ Parent or Legal Guardian School Schedule
CDC+ Parent or Legal Guardian Statement of Work Schedule
CDC+ Parent or Legal Guardian Work Schedule
CDC+ Parent/Legal Guardian Medical Limitations Form
CDC+ Physician Order for Services
CDC+ Physician Visit Documentation Form
CDC+ Plan of Care
CDC+ Reconsideration Request
CDC+ Supporting Documentation Requirements
CMS 485 Writable Plan of Care
Home Health Supporting Documentation Requirements
Home Health Work Schedule Statement from Employer
MEDICAID INSTRUCTIONS FOR CMS FORM 485 – PLAN OF CARE
Medicaid Physician Rx for Home Health Services
Parent or Legal Guardian Medical Limitations
Parent or Legal Guardian School Schedule
Parent or Legal Guardian Statement of Work Schedule
Physician Visit Documentation Form
POC Addendum
PPEC "writable" Plan of Care - 2013
PPEC POC - Word Document
PPEC Required Supporting Documentation - Updated Nov 2013
Reconsideration Review Request Form
Reconsideration Review Request Form Instructions
Request for Extension of Administrative Authorization of Services due to Fair Hearing
Respiratory Services Medical Necessity Review Request
Respiratory Services Medical Necessity Review Request~writable PDF
Unlicensed Independent PCS Provider Plan of Care (POC)
Unlicensed Independent Personal Care Services Required Supporting Documentation
Access Forms
|
Provider Manuals
|
Codes that require prior authorization
|
Forms and Downloads
|
eQSuite User Guides
|
Education and Training Resources
Copyright 2010 by eQHealth Solutions, Inc.
Privacy Statement
|
Terms Of Use
|
Login