The system administrator assigns and maintains logons for all eQSuite users assigned to enter PARs under that number. Please refer to the Prior Authorization section of the Aetna Better Health of Florida Provider Manual for additional information. Overview: eQHealth Solutions (eQHealth) developed a proprietary web-based electronic review request submission system, eQSuite®, that allows Providers to: • Submit authorizations to be reviewed for medical necessity and compliance. The program will also assist with providing improved care coordination between the Colorado Hospitals and the Regional Accountable Entities (RAEs). Improve health care equity, access and outcomes for the people we serve while saving Coloradans money on health care and driving value for Colorado. To ease provider burden during the COVID-19 pandemic, the Department will not be pending or technically denying DME Rule 8.590.2.M starting June 1st, 2020. Current authorizations with end dates after May 1st will remain effective until the end date on the PAR so you can proceed with submitting claims as you usually do. eQSuite is eQhealth Solutions' proprietary web-based, HIPPA compliant prior authorization system which offers providers 24/7 accessibility. Member Contact Center1-800-221-3943 / State Relay: 711. Utilization Management. These services were previously authorized through MedSolutions (eviCore). It is an approved and preferred option for providers to submit prior authorization requests, provide clinical information, and receive determination outcomes electronically. Prior Authorization. Improve health care equity, access and outcomes for the people we serve while saving Coloradans money on health care and driving value for Colorado. Providers must complete and submit the Request for eQSuite Access form. Prior authorization through eQSuite® is required when the item or service code requires an authorization as defined by the ColoradoPAR program. Keystone Peer Review Organization (Kepro) will be the new utilization management (UM) partner for Health First Colorado (Colorado's Medicaid Program) as previously announced in the February 2021 Provider Bulletin (B2100459). Effective Aug. 1, 2019, Alliant Health Solutions is now performing prior authorization reviews for the Mississippi Division of Medicaid as the agency’s new Utilization Management/Quality Improvement Organization (UM/QIO) vendor. eQ Health will process all prior authorization requests within seventy-two (72) hours of receipt of complete documentation clearly establishing medical necessity. *** ColoradoPAR does not review services for Behavioral Health Services, Dental/Orthodontia, Pharmacy, and Transportation. 434-5881) available on the Provider Forms web page ® under the Synagis Pharmacy Prior Authorization Request Form drop-down section. Prior Authorization Template and Instructions. Prior to March 1, 2016 advanced imaging services were prior authorized through MedSolutions (eviCore). 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. Providers are to continue coding claims and Prior Authorization Requests in their current manner. USHL partners with eQHealth Solutions to provide utilization management for all services that require prior authorization. eQHealth Solutions operates this website, which provides Care Coordination Software as a Service. eQSuite® Provider Portal is an all access entry into your prior authorization requests and determinations. As part of this program, Hospitals will be following the processes below and submit PAR's directly to eQHealth Solutions, via eQSuite: Please note: For the above categories, all PARs for clients age 20 and under are reviewed according to EPSDT guidelines. Visit "Where can I get vaccinated" or call 1-877-COVAXCO (1-877-268-2926) for vaccine information. Physician’s Office or Outpatient Facility Administration . Concurrent Review (or Continued Stay Review) - If a Health First Colorado member is still admitted as an inpatient on Day 4 and has one or more of the following conditions, Sepsis, Pneumonia, NICU and Acute Respiratory Failure, they will receive Complex Case Management to help to facilitate additional care coordination when appropriate. Providers are invited to complete a provider survey to share opinions on provider portal functionality and training. Key dates for the eQ to Kepro transition 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. The go-live date for Kepro has not yet been finalized, but additional announcements will be posted to this website and sent out via Provider Bulletin. Please note: PARs do not need to be submitted to the Department's Utilization Management (UM) vendor, eQHealth Solutions for dates of service beginning July 1, 2020. Home; Provider Resources. As a reminder from a previous communication, eQHealth's PAR portal, eQSuite®, will be available through May 31, 2021. EQHealth Solutions Sponsored By New Rules Let Floridians Raise Disabled Kids At Home The new rules, announced by Florida healthcare regulators, will affect hundreds of parents of disabled children. The Department has announced the intent to award the Utilization Management (UM) contract to Keystone Peer Review Organization (KEPRO). ABS partners with eQHealth Solutions to provide utilization management for all services that require prior authorization. prior authorization (PA) requests from providers on Aug. 1, 2019, and the implementation will be complete by Sept. 1, 2019. No longer accepting OCL and PASRR requests: The eQSuite® portal will no longer be accepting OCL and PASRR requests as of 2/26/2021.Please direct all new requests starting 3/1/2021 to the Telligen portal at www.myqualitrac.com. 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. If you have questions or concerns about the Inpatient Hospital Review Program (IHRP) you can email hcpf_hospitalreview@state.co.us. The IHRP will assist in ensuring that care is provided at the appropriate setting, duration and time as well as ensure there aren't other additional appropriate alternative services available. For 30 years, eQHealth Solutions has been improving healthcare quality and reducing costs through innovative technology, population health management solutions and medical management services. About us. Better manage expenses by improving utilization review, utilization management and prior authorization. Kepro currently holds both Quality Improvement Organization (QIO) and QIO-like designations from CMS. Together, eQHealth and HCPF will serve Medicaid members by focusing on and implementing HCPF’s mission to improve health care access and outcomes for the people we … For additional information on IHRP, please visit the. eQHealth Solutions also reviews eligibility for two waivers: Children's Home and Community-Based Services (CHCBS) and Children's Extensive Services (CES). Tampa, Florida 33634, Physical Therapy, Occupational Therapy (PT/OT), Member Contact Center1-800-221-3943 / State Relay: 711. 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. American Specialty Health 1-800-972-4226 . Please see the Provider Help page for additional information on these services. ColoradoPAR: Health First Colorado Prior Authorization Request Program, February 2021 Provider Bulletin (B2100459), Keystone Peer Review Organization Kepro Transition and Survey Results - March 25, 2021, Training for New Prior Authorization Portal - March 11, 2021, Training Information: New Utilization Management UM Vendor for Prior Authorizations - March 1, 2021, New Utilization Management UM Vendor for Prior Authorizations - February 22. A logon must be assigned and a system administrator designated for each individual provider number. This information is located within the Colorado Medicaid Billing Manuals or July 2015 Fee Schedule. For additional information on ColoradoPAR, please see the ColoradoPAR website. Kepro is Utilization Review Accreditation Commission (URAC) accredited and licensed to perform reviews in every state. 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. 8. If you have a previously approved PAR that needs to be canceled or rescheduled due to COVID-19 and the guidance from CMS and Governor Polis, you may request a date span adjustment of PAR Dates. Please visit the following website for … The Department’s prior authorization vendor, eQHealth Solutions, will be responsible for reviewing the medical necessity of medical PAR for Synagis ® Providers must complete and submit the Request for eQSuite Access form. Attention DMEPOS Suppliers: The 'multiple line item' policy instruction announced in the January 2021 Provider Bulletin is delayed until further notice due to operational issues. Also, you may contact customer service at 1-833-610-1053 for help regarding previously approved services or general questions. SafeGuard partners with eQHealth Solutions to provide utilization management for all services that require prior authorization. Effective April 3, 2020, Health First Colorado is waiving prior authorization requirements for oxygen therapy, positive airway pressure devices, respiratory assist devices, ventilators, suction devices, nebulizers and oxygen-related supplies that are emergently provided for COVID-19 treatment. Kepro brings 30+ years of Medicaid and Medicare experience, serving 27 Medicaid agencies over more than 20 years. 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. eQHealth Solutions was selected by the Department to provide utilization management services beginning September 1, 2015. eQHealth Solutions reviews and authorizes prior authorization requests (PARs) for the ColoradoPAR Program. Prior Authorization Requests (PARs) or Admission Reviews - Hospitals will be submitting based on established timelines before or shortly after admission for all services excluding the following, Members with Medicaid as a secondary payer, Admissions to long term rehabilitation facilities. More information on any of the services performed by the Department's UM Vendor, eQHealth Solutions, can be found by visiting the ColoradoPAR Provider Website or by contacting the ColoradoPAR Provider Helpline at 1-888-801-9355. 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. All live UM trainings presented by eQHealth Solutions, Inc are suspended as of January 4, 2021. LSU-First Medical Necessity Review Fax – 1-855-558-3723 Effective: 01/02/14 Version: 02/05/2015 Page 2 of 2 Clinical Summary Information- prior treatment … The Prior Authorization Template is optional, hospitals are not required to submit the form to eQHealth. For more information about the CHCBS waiver please review the Health First Colorado CHCBS Information page, and for additional information about CES please review Health First Colorado CES Information page. eQHealth Solutions is here to collaborate with your organization to help decrease your burden by managing your … For more information about the CHCBS waiver please review the Health First Colorado, More information on any of the services performed by the Department's UM Vendor, eQHealth Solutions, can be found by visiting the, If you have questions for the Department about the UM Vendor/Activities or the Colorado PAR Program you can email, If you have questions or concerns about the Inpatient Hospital Review Program (IHRP) you can email. Health 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. Additionally, eQHealth Solutions is responsible for reviewing Over Cost Containment (OCC). To go into a little more detail, all prior authorization reviews in process before Aug. 1 will be completed by eQHealth Solutions as part of the transition to Alliant. Visit "Where can I get vaccinated" or call 1-877-COVAXCO (1-877-268-2926) for vaccine information. All feedback will be considered to help make decisions regarding the UM program. 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. ColoradoPAR is the Health First Colorado (Colorado's Medicaid program)utilization management (UM) program. 2021, Health First Colorado News and Updates (B2100461 - April 2021), Health First Colorado News and Updates (B2100460 - March 2021), Health First Colorado News and Updates (B2100459 - February 2021), Durable Medical Equipment (DME) and Oxygen Supplies, How-to video tutorial: How to create a review (9mins 16 secs), How-to PowerPoint: 2020 CO Audiology PPT - Final (40 slides), User Guide in PDF: Audiology eQSuite User Guide, How-to video tutorial: How to create a review (9mins 20 secs), How-to PowerPoint: 2020 CO Diagnostic Imaging Final PPT - Final, User Guide in PDF: Diagnostic Imaging eQSuite User Guide, How-to video tutorial: How to create a review (10mins 51 secs), How-to PowerPoint: 2020 CO DME PPT - Final (54 slides), User Guide in PDF: DME eQSuite User Guide, User Guide in PDF: EPSDT User Guide & How to cancel a review in eQSuites, Additional training material: PDF: EPDST Exceptions to State Plan Benefit Limits and Coverage Standards Fact Sheet, How-to video tutorial: How to create a review (11mins 33 secs), How-to PowerPoint: 2020 CO LTSS PPT - Final (51 slides), How-to video tutorial: How to create a review (14mins 54 secs), How-to PowerPoint: 2020 CO Medical Services - FINAL (39 slides), User Guide in PDF: Surgical Services eQSuites User Guide, Video tutorial: TRANSPLANTS: how to create a review (10 mins 02 secs), Back and other Surgical Codes Requiring a PAR (XLS), Enter Prior Auth Surgeries and Transplants (PDF), How-to video tutorial: How to create a review (9mins 29 secs), User Guide in PDF: Molecular Testing eQSuite User Guide, How-to video tutorial: How to create a review (9mins 45 secs), How-to PowerPoint: PBT PPT Final August 2019, User Guide in PDF: PBT eQSuite User Guide, How-to PowerPoint: Pediatric Long Term Home Health Final August 2019, User Guide in PDF: PLTHH eQSuite User Guide, Reallocations CNA LTHH 2019 (Help Sheets for unit calculations), How-to video tutorial: How to create a review (12mins 29 secs- combined with ST), How-to PowerPoint: PTOT August 2019 PPT - Final, User Guide in PDF: PTOT eQSuite User Guide, How-to video tutorial: How to create a review (11mins 01 secs), How-to video tutorial: How to create a review (12mins 29 secs - combined with PT/OT), How-to PowerPoint: 2020 CO Speech Therapy PPT - Final (42 slides), User Guide in PDF: Speech Therapy eQSuite User Guide, How-to video tutorial: How to create a review (8 mins 5 secs), How-to PowerPoint: 2020 CO Synagis PPT - Final (36 slides), User Guide in PDF: 2020 Synagis eQSuite User Guide, 2021.How to Submit a Peer to Peer Request, 2021.How to Complete Change of Provider Form, 2020.CO Fax Exemption Form (PDF Fillable), CO.2020 CONTACT GUIDE (eQHealth, HCPF, Gainwell Technologies (formerly DXC)), CO.2020 eQSuite Access Form (PDF Fillable), CO.2020 Faxing a PAR to eQHealth Solutions, CO.2020 How to Cancel a Review in eQSuite, CO.2020 How to check the status of a review in eQSuite, CO.2020 How to Enter an Online Helpline Ticket, CO.2020 How to Submit Supporting Documentation in eQSuite, CO.2020 How to View Determination Letters in eQSuite, CO.2020 Minimum IT Requirements and Recommendations for eQSuite, How to respond to a pended review in eQSuite, How to Create Additional Users in eQSuite, How to submit an online helpline ticket in eQSuite, How to submit supporting documentation in eQSuite, How to view a determination letter in eQSuite, More information to come - please stayed tuned, Section to come once Inpatient is announced that it will be turned back on, More information to come - please stay tuned. Please ensure that you are receiving the Department's Provider bulletin by signing up to receive emails. US Health and Life requires prior authorization of certain services including: All inpatient admissions to any acute care facility require prior authorization and concurrent review. This is a reminder that the requirement for Prior Authorization Requests (PARs) are currently suspended for Pediatric Long-Term Home Health (PLTHH) and Private Duty Nursing (PDN) as of July 1, 2020. The program will also assist with providing improved care coordination between the Colorado Hospitals and the Regional Accountable Entities (RAEs). Requesting providers, including outpatient hospitals, must complete and fax the Prior Authorization Request Form found in the Forms section of the Provider Manual (Fax: 1-860-607-8056 /OB Fax: 1-860-607-8726 Fraud Waste and Abuse (FWA) To report suspected fraud, waste and abuse Hearing Care Solutions 1-877-583-2842 . Please see How to submit a PAR Date Span Adjustment for more information. Allow providers to easily track the status of their prior authorization requests (PARs) using a web portal, rather than a paper process. Any updates will be noticed via Provider Bulletins and the Department's project web page. Only submit clinical information that supports the request for service(s) to determine medical necessity or specifically requested byeQHealth Solutions. The ColoradoPAR vendor reviews the request to determine if services are medically necessary according to established criteria and guidelines. New in 2020 Prior Authorization with eQHealth. eQHealth Solutions 2050 - 10 Finley Road, Lombard, IL 60148 Business Phone: 630.317.5100 Business Fax: 630.317.5101 Review Certification Line: 800.418.4033 - Mon-Fri, 8:30 am to 5:00 pm, CST Select the resource you need by clicking the topic on the left. Prior Authorization Requests (PARs): Providers request authorization for services before providing certain services. Therefore, any requests submitted on or before July 31 “the State Defendants”), as well as eQHealth Solutions, Inc. (hereinafter “Defendant eQHealth”), a non-profit corporation with whom the State of Florida has contracted to provide prior authorization of home health services. This change does not impact Medicaid beneficiaries enrolled in the MS Coordinated Access Networks (MSCAN) 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. 5802 Benjamin Center Dr., Suite 105, The IHRP will assist in ensuring that care is provided at the appropriate setting, duration and time as well as ensure there aren't other additional appropriate alternative services available. step of what is being asked in the online Prior Authorization (PAR) portal, eQSuite Portal. •eQHealth began processing Prior Authorization requests for beneficiaries with a Tier 1 determination on January 1, 2019 for Inpatient and Outpatient Services •eQHealth processes prior authorizations for services under the Retro OBHS program for Tier 2 and 3 determinations received prior to March 1, 2019 A third-party vendor, eQHealth Solutions, reviews Prior Authorization Requests (PARs) to ensure items and services requested meet medical necessity guidelines and are compliant with Federal regulations and Health First Colorado's policies. We apologize for the confusion. If a PA request does not contain documentation clearly establishing that the requested services are medically necessary, … Effective March 1, 2016, eQHealth Solutions (eQHS) began performing prior authorization reviews for advanced imaging services, in accordance with Mississippi Administrative Code Title 23, Part 220 Radiology Services. Kepro delivers care management and quality oversight solutions using clinical expertise and technology-driven solutions to improve quality and clinical outcomes for vulnerable populations. How To Guides; Register for a webinar; Archived Bulletins; Behavior Analysis. Visit Mississippi Envision's website here. Additionally, managing unique cases and appeals process management through a strong provider network puts even more stress on your organization. Customer Service Line: 888-801-9355 (toll free), Provider Fax Line: 866-940-4288 (toll free), Mailing Address: eQHealth Solutions (Attn: Colorado Medicaid Program) Plaintiffs are children with complex medical … Additionally, eQHealth Solutions is responsible for reviewing Over Cost Containment (OCC). 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™. What is a prior authorization number? Kepro will replace eQHealth Solutions, Inc as the UM Vendor in Spring of 2021. New in 2020: Prior Authorization with eQHealth. Access Forms; Provider Manuals; Codes that require prior authorization Prior Authorization. The Inpatient Hospital Review Program (IHRP) is Health First Colorado's program to review all Inpatient Hospital Admissions to ensure appropriate care is provided in compliance with federal/state rules and regulations. For more information on eQHealth Solutions, … 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** The eQSuite Administrator Guide can be found on the Colorado PAR website. Kepro will have access to historical PAR data from the last 3 years, but the information and documentation will not be available to providers. If you have questions for the Department about the UM Vendor/Activities or the Colorado PAR Program you can email hcpf_UM@state.co.us. Information on the process of making a modification to a PAR that was completed by eQ will be available soon and sent out via email and provider bulletin. Providers should ensure any necessary documentation, including clinical documentation and determination letters, have been downloaded from the portal on or before May 31, 2021. All reviews will be conducted by a licensed speech, occupational or physical therapist depending on the type of service under review. Please visit Durable Medical Equipment (DME) and Oxygen Supplies for more information. If you are certain that eQHealth Suite is not already running and it is safe for you to proceed, you can Continue to Login. 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. 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. Prior Authorization Resources Page. The ColoradoPAR Program reviews PARs for the following categories of services and supplies: Medical services (including select restorative, back, transplant, bariatric surgeries), Speech Therapy: Habilitative and Outpatient, The Inpatient Hospital Review Program (IHRP) is Health First Colorado's program to review all Inpatient Hospital Admissions to ensure appropriate care is provided in compliance with federal/state rules and regulations. 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. For additional information on IHRP, please visit the IHRP Provider page. 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. Providers will still have access to the prerecorded eQHealth trainings on the ColoradoPAR website under Provider resources Providers can request a live training and or 1:1 help session if needed by sending an email to eQHealth\'s Provider relations team at co.pr@eqhs.com.
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