eq solutions prior authorization form

eQHealth Solutions operates this website, which provides Care Coordination Software as a Service. /Tx BMC 0.749023 g It appears that eQHealth Suite is already running. endstream endobj 40 0 obj <>/Subtype/Form/Type/XObject>>stream EMC /Tx BMC EMC EMC /Tx BMC endstream endobj 43 0 obj <>/Subtype/Form/Type/XObject>>stream /Tx BMC /Tx BMC /Tx BMC /Tx BMC Utilization Review/Prior Authorization Request Pricing Information Schedule A Demo. EMC f 0 0 18 18 re Home; Provider Resources. EMC endstream endobj 101 0 obj <>/Subtype/Form/Type/XObject>>stream This page is used to inform website visitors regarding our policies with the collection, use, and disclosure of electronic Protected Health Information (ePHI) if anyone decided to use our Service, the eQSuite | Care Coordination website. For more information on eQHealth Solutions… endstream endobj 82 0 obj <>/Subtype/Form/Type/XObject>>stream Medicaid Provider Address Change. �sr � � EMC Medical Necessity Review/Prior Authorization Request Form Fax: 866-337-8690 Mail: eQHealth Solutions 1431 Greenway Drive Suite 500 Irving, TX 75038 Page 1 of 2 Effective: 12/05/2019 Version: 12/04/2019 **PLEASE PRINT** **PLEASE PRINT** �sr � � EMC Only submit clinical information that supports the request for service(s) to determine medical necessity or specifically requested byeQHealth Solutions. endstream endobj 126 0 obj <>stream endobj Call us toll-free. endstream endobj 123 0 obj <>/Subtype/Form/Type/XObject>>stream endstream endobj 97 0 obj <>/Subtype/Form/Type/XObject>>stream endstream endobj 62 0 obj <>/Subtype/Form/Type/XObject>>stream /Tx BMC EMC f It is an approved and preferred option for providers to submit prior authorization requests, provide clinical information, and receive determination outcomes electronically. endstream endobj 34 0 obj <>/Subtype/Form/Type/XObject>>stream /Tx BMC eQSuite® Provider Portal is an all access entry into your prior authorization requests and determinations. 3 0 obj ��2�s��BD*( eQHealth Solutions is a population health management and IT solutions company that is accredited by URAC in Health Utilization Management and has more than 30 years of experience providing utilization management expertise in all 50 states. endstream endobj 112 0 obj <>/Subtype/Form/Type/XObject>>stream endstream endobj 122 0 obj <>/Subtype/Form/Type/XObject>>stream EMC /Tx BMC EMC The form is designed to serve as a standardized prior authorization form accepted by multiple health plans. endstream endobj 36 0 obj <>/Subtype/Form/Type/XObject>>stream <> endstream endobj 66 0 obj <>/Subtype/Form/Type/XObject>>stream [zq�D/��u��(�U��W�>�n�V��G��Ի��7�{u��4�3��{�y�{ww��>�:�2��+��x��;�HDzq��n6��F�7��|��|p��j&��*�f�Ö/��C��u��̗+פ7�͗뼮�r�\n�&ϊ��0�l��ի�1�wL�C��˘�̴@��B�/��kJ�>��!kr�i��x&��m0��v��q�V`�|; b�6"�of�p2�AI衅��~ۺ�Iβ��Æ'� h'�� K5G�,x,��L��s�C�� *��}�ᝪ�CU/Tup�3�T8��G�Pg EMC Access Forms; Provider Manuals; Codes that require prior authorization EMC endstream endobj 64 0 obj <>/Subtype/Form/Type/XObject>>stream eQSuite® is our proprietary web-based, HIPPA compliant prior authorization system which offers providers 24/7 accessibility to the information they need. endstream endobj 92 0 obj <>/Subtype/Form/Type/XObject>>stream EMC 0 0 18 18 re /Tx BMC endstream endobj 78 0 obj <>/Subtype/Form/Type/XObject>>stream The following three contacts at your facility play a … The Agency for Health Care Administration has contracted with a certified Quality Improvement Organization (QIO), eQHealth Solutions, Inc. to provide medical necessity reviews for Medicaid home health services. endstream endobj 71 0 obj <>/Subtype/Form/Type/XObject>>stream /Tx BMC /Tx BMC 30 0 obj <> endobj 0 0 18 18 re /Tx BMC /Tx BMC /Tx BMC H�2�37�402VH�2P0P0� ��T�4�B.C 4!�@8W��$�r� R�@Q��+� � Rn' endstream endobj 93 0 obj <>/Subtype/Form/Type/XObject>>stream %PDF-1.7 f endstream endobj 46 0 obj <>/Subtype/Form/Type/XObject>>stream Our Utilization Review (UR) and … /Tx BMC �sr � � f Services include: prior authorization and utilization review, care coordination, quality improvement activities, medical record review, health and wellness, and quality review services for home and community based waiver programs. endstream endobj 85 0 obj <>/Subtype/Form/Type/XObject>>stream f endstream endobj 61 0 obj <>/Subtype/Form/Type/XObject>>stream 5%w)CA3�BQ��!R�A��KqX��/�7C�TJ�] EMC Webinars endstream endobj 42 0 obj <>/Subtype/Form/Type/XObject>>stream K�P�8\H�@M��*��~��-�0�;ۄQC*I¸��0Ia�d S�K�0��B$�%e�1p�� pű�I��l��I�YH� x��(2�a�)�.��HN� �)9̥t"��Hk,\�D1�5I��@�j�(�siXƠ��o�D+��J��!�g��c�=�i��!�1:��X ��&��K�D�4V�B�X��b Af�b�RPGjD��(�N�E-��Z��H�BXWa�#`۠�XGH�=��HE��%��3�|��9�(g��2��\��2G��Il��1�[h�m�4Va? endstream endobj 54 0 obj <>/Subtype/Form/Type/XObject>>stream H�*�2T B3*J� Details: eQHealth Solutions is the new vendor partner that is providing utilization management services for Ascension SmartHealth beginning Jan. 1, 2020. eQHealth has a portal to submit prior authorization requests which allows for immediate authorization in certain cases when criteria is met based on clinical documentation provided. 0.749023 g EMC /Tx BMC <> H�*�2T B3*J� Parent or Legal Guardian Medical Limitation Form. endstream endobj 94 0 obj <>/Subtype/Form/Type/XObject>>stream /Tx BMC EMC EMC endstream endobj 75 0 obj <>/Subtype/Form/Type/XObject>>stream 2 0 obj endstream endobj 69 0 obj <>/Subtype/Form/Type/XObject>>stream ��2�s��BD*( EMC )�ΈEM��8� /Tx BMC H�2�37�402VH�2P0P0� ��T�4�B.C 4!�@8W��$�r� R�@Q��+� � Rn' Type of Review Request Documentation All Types of Review Requests Documentation not included in the review request form that supports the medically necessity of the requested services. Ability to document and track peer-to-peer conversations, reconsideration reviews and multi-level appeal processes. EMC Home; Provider Resources. �sr � � Q14. Prior Authorization. 4 0 obj /Tx BMC Untitled Page. 0 0 18 18 re Forms - il.eqhs.com. Reconsideration Review Request Form. EMC endstream endobj 73 0 obj <>/Subtype/Form/Type/XObject>>stream /Tx BMC endstream endobj 111 0 obj <>/Subtype/Form/Type/XObject>>stream /Tx BMC How To Guides; Register for a webinar; Archived Bulletins; Behavior Analysis. endstream endobj 74 0 obj <>/Subtype/Form/Type/XObject>>stream EMC endstream endobj 79 0 obj <>/Subtype/Form/Type/XObject>>stream <>/ExtGState<>/XObject<>/ProcSet[/PDF/Text/ImageB/ImageC/ImageI] >>/MediaBox[ 0 0 612 792] /Contents 4 0 R/Group<>/Tabs/S/StructParents 0>> /Tx BMC /Tx BMC H�*�2T B3*J� Access Forms; Provider Manuals; Codes that require prior authorization Eq Health Pre Authorization Form. Maternity & Newborn Authorization Requirements (After 7/1/13) Maternity & Newborn Authorization Requirements (Prior to 7/1/13) Out of state Authorization Process and Guidelines. 0 0 18 18 re EMC endstream endobj 89 0 obj <>/Subtype/Form/Type/XObject>>stream endstream endobj 90 0 obj <>/Subtype/Form/Type/XObject>>stream f endstream endobj 59 0 obj <>/Subtype/Form/Type/XObject>>stream Type of Review Request Documentation All Types of Review Requests Documentation not included in the review request form that supports the medically necessity of the requested services. ��2�s��BD*( 0 /Tx BMC Health Details: Womens Health New in 2020 Prior Authorization with eQHealth Details: The portal is the preferred method for the submission of prior authorization requests, however requests can still be sent via fax by completing the new prior authorization form or by calling eQhealth directly at 866-356-3666. smart health prior authorization request form These services were previously authorized through MedSolutions (eviCore). Parent or Legal Guardian School Schedule Form. endstream endobj 83 0 obj <>/Subtype/Form/Type/XObject>>stream /Tx BMC EMC endstream endobj 118 0 obj <>/Subtype/Form/Type/XObject>>stream endstream endobj 38 0 obj <>/Subtype/Form/Type/XObject>>stream endstream endobj 53 0 obj <>/Subtype/Form/Type/XObject>>stream EMC /Tx BMC !! eQ Care ® Services Population Health Management / Care Coordination Medical Management Comprehensive Primary Care Plus (CPC+) Markets Patient & Value Centered Organizations Payer & Administration Organizations Provider Organizations eQ Health Difference CMS Certified Care Management High-Tech & High-Touch Solutions eQ Health will process all prior authorization requests within seventy-two (72) hours of receipt of complete documentation clearly establishing medical necessity. EMC endstream endobj 107 0 obj <>/Subtype/Form/Type/XObject>>stream endstream endobj startxref f ��2�s��BD*( h��[mo�8��+�8�ݱ��r�(�6�Np�i�$��)��j3�0��ns��e��h��n�"E��P,! If you are certain that eQHealth Suite is not already running and it is safe for you to proceed, you can Continue to Login . endstream endobj 114 0 obj <>/Subtype/Form/Type/XObject>>stream 0.749023 g EMC EMC /Tx BMC In the menu above, there are links to eQHealth Solutions Education resources, Contact information, the Advanced Imaging Provider Manual and forms, and Reconsideration Information. endstream endobj 60 0 obj <>/Subtype/Form/Type/XObject>>stream EMC The Prior Authorization Template is optional, hospitals are not required to submit the form to eQHealth. Disclaimer Statement eQHealth Solutions … endstream endobj 49 0 obj <>/Subtype/Form/Type/XObject>>stream /Tx BMC endstream endobj 55 0 obj <>/Subtype/Form/Type/XObject>>stream /Tx BMC endstream endobj 41 0 obj <>/Subtype/Form/Type/XObject>>stream !! eQHealth Solutions 2050 - 10 Finley Road, Lombard, IL 60148 Business Phone: 630.317.5100 Business Fax: 630.317.5101 endstream endobj 102 0 obj <>/Subtype/Form/Type/XObject>>stream /Tx BMC endstream endobj 56 0 obj <>/Subtype/Form/Type/XObject>>stream 225 0 obj <>stream endstream endobj 125 0 obj <>/Subtype/Form/Type/XObject>>stream H�*�2T B3*J� endstream endobj 108 0 obj <>/Subtype/Form/Type/XObject>>stream Effective March 1, 2016, eQHealth Solutions began performing prior authorization reviews for advanced imaging services, in accordance with Mississippi Administrative Code Title 23, Part 220 Radiology Services. EMC Individual Provider Training Request Form. �H%'a�F�V�Pv��)9PA� ��o��GW|��?��8�,�e�Y��r�6$LC��^�妁�o�m� Mh�`5��E��sW,�Ohb�� "�6��t��d��㕎��e��#=��HOGz:�ӑ��t��#=�H�Dz&�3��L�g"=�H�Dz6ҳ��l�g#=��H�Fz6ҳ��q(i,Y,y,E,e,U,u,M,#=��H�Fz�\��^D�YD�e[F�e�/#�2b��k! H�2�37�402VH�2P0P0� ��T�4�B.C 4!�@8W��$�r� R�@Q��+� � Rn' <>/Metadata 241 0 R/ViewerPreferences 242 0 R>> endstream endobj 117 0 obj <>/Subtype/Form/Type/XObject>>stream Prior Authorization Request Form Fax to 586-693-4829 Effective: 01/01/2020 Version: 12/10/2019 Page 2 of 2 SUPPORTING DOCUMENTATION The following documentation is not required but may be submitted. f /Tx BMC Physician Visit Documentation Form. endstream endobj 52 0 obj <>/Subtype/Form/Type/XObject>>stream How To Guides; Register for a webinar; Archived Bulletins; Behavior Analysis. f /Tx BMC Overview of Services A. eQHealth Solutions – Illinois’ Quality Improvement Organization eQHealth Solutions, Inc. (eQHealth), under contract to Healthcare and Family Services (HFS) since 2002, EMC endstream endobj 35 0 obj <>/Subtype/Form/Type/XObject>>stream endstream endobj 45 0 obj <>/Subtype/Form/Type/XObject>>stream endstream endobj 51 0 obj <>/Subtype/Form/Type/XObject>>stream 0 0 18 18 re endstream endobj 68 0 obj <>/Subtype/Form/Type/XObject>>stream �sr � � New in 2020: Prior Authorization with eQHealth January 15, 2020 eQHealth Solutions is the new vendor partner that is providing utilization management services for Ascension SmartHealth beginning Jan. 1, 2020. eQHealth has a portal to submit prior authorization requests which allows for immediate authorization in certain cases when criteria is met based on clinical documentation provided. H�2�37�402VH�2P0P0� ��T�4�B.C 4!�@8W��$�r� R�@Q��+� � Rn' eQSuite® Training Training Schedules, Register for Webinars, How to Guides and Frequently Asked Questons. Parent or Legal Guardian Work Schedule Form. endstream endobj 88 0 obj <>/Subtype/Form/Type/XObject>>stream ��LZ�6Ȫ�cI��P`��Z�jw�i�F�?x��e�af ��*� ��aT�Շ��j(�3 eQ Care ® Services Population Health Management / Care Coordination Medical Management Comprehensive Primary Care Plus (CPC+) Markets Patient & Value Centered Organizations Payer & Administration Organizations Provider Organizations eQ Health Difference CMS Certified Care Management High-Tech & High-Touch Solutions EMC eQHealth Solutions, established in 1986, is a population health management and healthcare IT solutions company that touches millions of lives every year. �sr � � ��k�� Standard corporate-wide system patching is done on the third Wednesday of each month. /Tx BMC EMC endstream endobj 98 0 obj <>/Subtype/Form/Type/XObject>>stream /Tx BMC /Tx BMC EMC endstream endobj 63 0 obj <>/Subtype/Form/Type/XObject>>stream /Tx BMC 0 0 18 18 re /Tx BMC endstream endobj 105 0 obj <>/Subtype/Form/Type/XObject>>stream EMC 0.749023 g Disclaimer Statement eQHealth Solutions certification determination does not guarantee payment for services. EMC ABS partners with eQHealth Solutions to provide utilization management for all services that require prior authorization. 0.749023 g Running multiple copies of eQHealth Suite at the same time will cause errors! /Tx BMC 0.749023 g endstream endobj 65 0 obj <>/Subtype/Form/Type/XObject>>stream H�2�37�402VH�2P0P0� ��T�4�B.C 4!�@8W��$�r� R�@Q��+� � Rn' endstream endobj 70 0 obj <>/Subtype/Form/Type/XObject>>stream eQSuite is our proprietary web-based, HIPPA compliant prior authorization system which offers providers 24/7 accessibility to the information they need. endstream endobj 81 0 obj <>/Subtype/Form/Type/XObject>>stream eQSuite is eQHealth Solutions' proprietary, web-based, HIPAA-compliant prior authorization request system, which offers providers 24/7 accessibility to the information and functions providers need. endstream endobj 109 0 obj <>/Subtype/Form/Type/XObject>>stream EMC Providers must complete and submit the Request for eQSuite Access form. endstream endobj 103 0 obj <>/Subtype/Form/Type/XObject>>stream endstream endobj 106 0 obj <>/Subtype/Form/Type/XObject>>stream endstream endobj 44 0 obj <>/Subtype/Form/Type/XObject>>stream Physicians Order for Services Form. 0.749023 g ��2�s��BD*( /Tx BMC eQSuite is eQHealth Solutions' proprietary, web-based, HIPAA-compliant prior authorization request system, which offers providers 24/7 accessibility to the information and functions providers need. endstream endobj 116 0 obj <>/Subtype/Form/Type/XObject>>stream 0.749023 g Key dates for the eQ to Kepro transition 141 0 obj <>/Filter/FlateDecode/ID[<354B725D7D0FE04BA49808A6AF3F2E2A>]/Index[30 196]/Info 29 0 R/Length 196/Prev 116630/Root 31 0 R/Size 226/Type/XRef/W[1 3 1]>>stream endstream endobj 110 0 obj <>/Subtype/Form/Type/XObject>>stream H�*�2T B3*J� EMC eQHealth Solutions is here to collaborate with your organization to help decrease your burden by managing your utilization review and prior authorization needs. endstream endobj 76 0 obj <>/Subtype/Form/Type/XObject>>stream �sr � � /Tx BMC H�*�2T B3*J� endstream endobj 121 0 obj <>/Subtype/Form/Type/XObject>>stream stream �sr � � Forms. EMC eQHealth Fax Cover Sheet. endstream endobj 72 0 obj <>/Subtype/Form/Type/XObject>>stream ��2�s��BD*( H�2�37�402VH�2P0P0� ��T�4�B.C 4!�@8W��$�r� R�@Q��+� � Rn' h�bbd```b``�� )D2��"��"�p��v�ɕ8��F�� EMC endstream endobj 120 0 obj <>/Subtype/Form/Type/XObject>>stream H�2�37�402VH�2P0P0� ��T�4�B.C 4!�@8W��$�r� R�@Q��+� � Rn' f H�2�37�402VH�2P0P0� ��T�4�B.C 4!�@8W��$�r� R�@Q��+� � Rn' ϰ�Spq�� endstream endobj 113 0 obj <>/Subtype/Form/Type/XObject>>stream ��2�s��BD*( endstream endobj 58 0 obj <>/Subtype/Form/Type/XObject>>stream Prescription prior authorization forms are used by physicians who wish to request insurance coverage for non-preferred prescriptions.A non-preferred drug is a drug that is not listed on the Preferred Drug List (PDL) of a given insurance provider or State. H�*�2T B3*J� Overview of Services A. eQHealth Solutions – Illinois’ Quality Improvement Organization eQHealth Solutions… All reviews will be conducted by a licensed speech, occupational or physical therapist depending on the type of service under review. Solutions. Effective August 1, 2019, the Mississippi Division of Medicaid transitioned Utilization Management and Quality Improvement services to Alliant Health Solutions … /Tx BMC endstream endobj 47 0 obj <>/Subtype/Form/Type/XObject>>stream H�*�2T B3*J� /Tx BMC How To Guides; Register for a webinar; Archived Bulletins; Behavior Analysis. H�2�37�402VH�2P0P0� ��T�4�B.C 4!�@8W��$�r� R�@Q��+� � Rn' Access Forms; Provider Manuals; Codes that require prior authorization �sr � � How To Guides; Register for a webinar; Archived Bulletins; Behavior Analysis. f EMC eQHealth Solutions … endstream endobj 124 0 obj <>/Subtype/Form/Type/XObject>>stream /Tx BMC 0 0 18 18 re Health Details: Hospital Contact Form eQHealth Solutions keeps the hospital community informed of Healthcare and Family Services (HFS) program changes and sends review notices and updates through communication sent by fax, mail or phone.The following three contacts at your facility play a vital role in receiving and disseminating this information: eq health prior authorization endobj ��2�s��BD*( endstream endobj 91 0 obj <>/Subtype/Form/Type/XObject>>stream PCS Plan of Care Form-Unlicensed Independent. Have any questions? /Tx BMC eQHealth Solutions keeps the hospital community informed of Healthcare and Family Services (HFS) program changes and sends review notices and updates through communication sent by fax, mail or phone. EMC endstream endobj 77 0 obj <>/Subtype/Form/Type/XObject>>stream /Tx BMC 0.749023 g endstream endobj 48 0 obj <>/Subtype/Form/Type/XObject>>stream endstream endobj 67 0 obj <>/Subtype/Form/Type/XObject>>stream Home; Provider Resources. ��2�s��BD*( endstream endobj 104 0 obj <>/Subtype/Form/Type/XObject>>stream EMC eQHealth Solutions 2050 - 10 Finley Road, Lombard, IL 60148 Business Phone: 630.317.5100 Business Fax: 630.317.5101 f H�2�37�402VH�2P0P0� ��T�4�B.C 4!�@8W��$�r� R�@Q��+� � Rn' Kepro is replacing eQHealth Solutions, Inc. and will begin to receive Prior Authorization Requests (PARs) for all Fee For Service Health First Colorado Benefits that eQHealth Solutions, Inc. currently authorizes on May 1, 2021. eQ to Kepro Transition Timeline. ��2�s��BD*( /Tx BMC EMC EMC EMC endstream endobj 37 0 obj <>/Subtype/Form/Type/XObject>>stream EMC It is intended to assist providers by streamlining the data submission process for selected services that require prior authorization. /Tx BMC It is intended to assist providers by streamlining the data submission process for selected services that require prior authorization. /Tx BMC The form is designed to serve as a standardized prior authorization form accepted by multiple health plans. Advanced Imaging. H�2�37�402VH�2P0P0� ��T�4�B.C 4!�@8W��$�r� R�@Q��+� � Rn' Induction of Labor - Clinical Considerations and Recommendations. Prior authorization, concurrent, and retrospective reviews. 0 0 18 18 re endstream endobj 50 0 obj <>/Subtype/Form/Type/XObject>>stream ��2�s��BD*( endstream endobj 86 0 obj <>/Subtype/Form/Type/XObject>>stream endstream endobj 115 0 obj <>/Subtype/Form/Type/XObject>>stream Webinar Power Point Trainings. /Tx BMC PCS Required Supporting Documentation. EMC Home; Provider Resources. Eligibility for and Solutions. eQHealth Solutions is here to collaborate with your organization to help decrease your burden by managing your utilization review and prior authorization needs. 1-800-720-2578. Solutions eQSuite® Technology Clinical Integration Framework Business Intelligence & Healthcare Analytics … ɰI/�d؅�wdqd��DV!��I�*$�+0ԯDW��B��F��B�4g5�W�� dQ�l�`v��Nc�`��TT��@��=�d��"�� N30�'�P\��#�� `~JM eQSuite Training References. Providers must complete and submit the Request for eQSuite Access form. Fax request form - Non-Personal Care Providers. endstream endobj 31 0 obj <> endobj 32 0 obj <>/ExtGState<>/Font<>/ProcSet[/PDF/Text/ImageC]/XObject<>>>/Rotate 0/Type/Page>> endobj 33 0 obj <>/Subtype/Form/Type/XObject>>stream endstream endobj 100 0 obj <>/Subtype/Form/Type/XObject>>stream endstream endobj 96 0 obj <>/Subtype/Form/Type/XObject>>stream EMC EMC eQSuite® Login. 0 0 18 18 re EMC /Tx BMC In the menu above, there are links to eQHealth Solutions Education resources, Contact information, the Advanced Imaging Provider Manual and forms, and Reconsideration Information. x��]�o��n��rT+�� ْ[�� "P�r�-)�ى��?3�{'yw�%�}RT��o8g��n2�pq9i��x2��u��_oG��/��୿�.ޏ��'Ϛ�?�Z�F4V�FX�:�պ�n��|�\?~�K��>�o�i�?� ��r�Xx�|�b~g��ǏXsE��ן?�i�bx��x��9��W�� O�&]�ߏ�n0�ڼ��2. �sr � � Out Of State -Authorization Request Form. EMC The Prior Authorization Template can be used by hospitals as a tool to gather all the pertinent clinical information from the attending (surgeon) physician prior to submitting a request via eQSuite™. EMC EMC 0 0 18 18 re endstream endobj 119 0 obj <>/Subtype/Form/Type/XObject>>stream Multi-faceted ability to receive UM requests via web-based entry on a provider portal, call center and/or fax submission and tracking. 0.749023 g h�b```e````g`P�� Ȁ �@1v��yN0��I��{�l��i^uX D�@ `c`\% �s��,��Q��v]!��,��d� ˺0X1f0)0^�vd�k��(f4`P�p�|f� v`h`dPa�`�``P`p`d` ��\0W��8 � (��)V� e�1�/oSa�&tEn�Ƀ��G��i�p�N�wDd>P9� ��f`�(� ��=�Nf`�{$��"�.�F!�S�:1'��S��KE��Ʒw��ޞ�6rc�֨)/ڕܜ��s��IĄ�� ?_�kYpwsX�MÄ�EW��j�X�"��F�e�b L�n� endstream endobj 39 0 obj <>/Subtype/Form/Type/XObject>>stream EMC H�*�2T B3*J� /Tx BMC 0 0 18 18 re H�*�2T B3*J� EMC endstream endobj 99 0 obj <>/Subtype/Form/Type/XObject>>stream /Tx BMC /Tx BMC Effective: March 1, 2014 Prior Authorization of Elective Procedures eQHealth Solutions 4 of 27 II. endstream endobj 84 0 obj <>/Subtype/Form/Type/XObject>>stream endobj %%EOF /Tx BMC endstream endobj 80 0 obj <>/Subtype/Form/Type/XObject>>stream 0.749023 g 1 0 obj endstream endobj 87 0 obj <>/Subtype/Form/Type/XObject>>stream If the primary dx code submitted for Prior Authorization review changes, do we need to contact eQHealth to change it on the review? EMC Please direct all new requests starting 3/1/2021 to the Telligen portal at www.myqualitrac.com. %PDF-1.6 %�� Prior Authorization Request Form Fax to 586-693-4829 Effective: 01/01/2020 Version: 12/05/2019 Page 2 of 2 SUPPORTING DOCUMENTATION The following documentation is not required but may be submitted. �sr � � Fax request form - Personal Care Service Providers. H�*�2T B3*J� /Tx BMC H�*�2T B3*J� EMC Forms & Downloads. Our Utilization Review (UR) and Utilization Management (UM) workflows and processes include a network of professional service representatives backed by a highly experienced clinical staff of nurses and physicians. Effective: March 1, 2014 Prior Authorization of Elective Procedures eQHealth Solutions 4 of 27 II. Only submit clinical information that supports the request for service(s) to determine medical necessity or specifically requested byeQHealth Solutions. H�2�37�402VH�2P0P0� ��T�4�B.C 4!�@8W��$�r� R�@Q��+� � Rn' endstream endobj 57 0 obj <>/Subtype/Form/Type/XObject>>stream Access Forms; Provider Manuals; Codes that require prior authorization �h�,D�. endstream endobj 95 0 obj <>/Subtype/Form/Type/XObject>>stream No longer accepting OCL and PASRR requests: The eQSuite® portal will no longer be accepting OCL and PASRR requests as of 2/26/2021. �sr � � 0.749023 g ��2�s��BD*( %��
Mireille Blanco Heute, Robert Klauß Matchplan, Bahnhof Dübendorf öffnungszeiten, Eq Health Prior Authorization, Dayot Upamecano Vertrag, Wendler Yacht Egal, Das Böse Unter Der Sonne Synchronsprecher,