2018 Hospital UR Plan Submission
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 2018 UR PLANS MUST BE SUBMITTED NO LATER THAN JUNE 15th, 2018.
- 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.
Attention PAC Waiver Providers
PAC Waiver has transitioned to Managed Care, effective January 1, 2018. For additional information, please visit the Agency’s website for information on Florida Medicaid’s PAC Waiver Changes :
Florida Medicaid PAC Waiver changes (Click Here)
Attention Home Health Providers
Home health administrators, directors of nursing, billing staff, as well as other designated individuals are encouraged to attend training on the Electronic Visit Verification (EVV) System.
Please visit the EVV Training page to sign up for training session date(s) and time(s) that best fits your schedule.
Hurricane Irma Update from eQHealth Solutions:
Given the recent events of Hurricane Irma, we would like to share that eQHealth Solutions is fully operational at this time.
We are working closely with AHCA to ensure that your needs are met, and we invite you to notify us immediately should you encounter any difficulties with our systems or processes. Please dial 855-444-3747 for Customer Support.
Our thoughts go out to those affected by Hurricane Irma, and we’re committed to providing you with the support you need during recovery
Hurricane Irma - Message from AHCA:
Behavior Analysis Providers
We are inviting you to a webinar that will be held next week for Behavior Analysis providers. This webinar will be a review of eQSuite and how to enter a request for a modification. We will also have a Q&A session to go over any questions you may have. If you are not able to attend, we will be recording the session and posting it to our website for you to review at your convenience.
Date: Wednesday, May 9th, 2018 at 10:00am Est
Training Registration (Click Here)
We recently had our Phase 2 Training, if you were not able to attend you can watch the training via the link below.
Phase 2 Training (Click Here)
You can now view the FAQ's from the Phase 1 Webinar via the link below.
BA FAQs (Click Here)
Behavior Analysis-Phase 1
Reminder: If you need more units than the allowed amount in Phase 1, these requests must be faxed to us. The fax must clearly indicate that it is request for additional units. You can use the fax cover below.
BA fax coversheet-Click Here
Attention DME Providers-Recipients over the age of 21
When requesting authorization for a DME item please make sure you are referencing the Florida Medicaid Fee Schedule for the appropriate HCPCS Code. We have recently seen an increase of reviews submitted with the A9900 code. Please note A9900 is a -Misc DME Supply, accessory, and/or service component of another HCPCS Code .
(Example: briefs, diapers, protective underwear, pull-ons, liners, shields, guards, pads, wipes and undergarments)
You can reference the FL DME Imitations Handbook for additional information pp2-8.
PDN and PCS Providers
There have been recent changes to the Florida Medicaid Policy for Personal Care Services and Private Duty Nursing. You can find this policy by clicking on one of the links below.
FL Medicaid Coverage Policy for Personal Care Services
FL Medicaid Coverage Policy for PDN Services
One of the biggest changes is that you are now be able to request up to 180 days for all admission requests. Please make sure that if you are requesting 180 days that the prescription for services match your request.
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.
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
PACWAIVER FAXED REQUESTS
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 firstname.lastname@example.org
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.