Provider Services and Resources Hospital Contact Information Submitting Prior Authorization Requests Review Requests and Determinations Utilization Review Process Reconsideration Process Notifications of Review Outcome HFS Attachment F Procedures Subject to Review – Forms and Instructions Overview of and Summary of Provider Reports eQSuite™ I. Getting Started Certification at a Glance – Healthcare and Family Services IMPORTANT: Providers must read and and procedures located at be familiar with HFS’ policies Before submitting any request to eQHealth, providers must Medicaid eligibility and . check the Participant’s service limit information through Healthcare and Family eligibility verification channels. Services’ Requests for Prior Authorization (PA) must be submitted to eQHealth Solutions with the following information Participant name and 9-digit Medicaid ID number. Admitting physician (surgeon) 9-digit IL Medicaid ID and phone number The ICD9CM admitting diagnosis code The ICD9CM procedure code associated with CPT codes The IL Medicaid Provider ID where participant hospital’s 12-digit will have procedure performed Clinical information related to proposed procedure To assist hospitals, a template is available for surgeon (office) to provide you with information needed for utilization review. The templates are available in Section IV of this document. Prior authorization review is strictly for certification (prior authorization) of specific procedures. This is not an inpatient admission (concurrent) review. Prior authorization is required regardless of reimbursement type (DRG or Per Diem).
Provider Services and Resources Hospital Contact Information Submitting Prior Authorization Requests Review Requests and Determinations Utilization Review Process Reconsideration Process Notifications of Review Outcome HFS Attachment F – Procedures Subject to Review Forms and Instructions Overview of eQSuite™ and Summary of Provider Reports I. Getting Started – Certification at a Glance Healthcare and Family Services IMPORTANT: Providers must read and be familiar with HFS’ policies and procedures located at . Before submitting any request to eQHealth, providers must check the Participant’s Medicaid eligibility and service limit information through Healthcare and Family Services’ eligibility verification channels. Requests for Prior Authorization (PA) must be submitted to eQHealth Solutions with the following information Participant name and 9-digit Medicaid ID number. Admitting physician (surgeon) 9-digit IL Medicaid ID and phone number The ICD9CM admitting diagnosis code The ICD9CM procedure code associated with CPT codes The hospital’s 12-digit IL Medicaid Provider ID where participant will have procedure performed Clinical information related to proposed procedure To assist hospitals, a template is available for surgeon (office) to provide you with information needed for utilization review. The templates are available in Section IV of this document. Prior authorization review is strictly for certification (prior authorization) of specific procedures. This is not an inpatient admission (concurrent) review. Prior authorization is required regardless of reimbursement type (DRG or Per Diem).
Prior%20Auth%20Provider%20Manual%20Rev%201.docx