section of our homepage. Submitting Prior Authorization Requests Prior authorization (PA) review requests are submitted electronically using eQHealth’s proprietary Web-based software, eQSuite™. Thousands of healthcare professionals submit review requests and receive certification responses via the Web. HIPAA secure, Web-based system eQSuite provides 24/7 access to: eQHealth’s – ™ Submit review requests Check status of your Web submitted review Provide additional information when requested by eQHealth Submit online helpline queries View or print provider-specific notification/determination letters Run provider-specific reports with review data For more information on the Web system, see Section V of this manual. Web Administrator The Web Administrator will have rights to create a Provider profile for each user to grant access to and maintain User IDs and passwords. eQSuite™ If the hospital does not currently have a Web Administrator, you must appoint one. Managing system access and users is a non-technical process. A Hospital Contact Form is available on our Website. Review Requests and Determination Timeframes Description Request Method Requirements/Timeframe Determination Mandatory prior The hospital must Requests must be submitted to eQHealth will render authorization of obtain prior eQHealth via the Web: a medical necessity non-emergent, authorization of determination in 2 Up to 30 calendar days prior procedures subject business days from CABG and back to procedure date surgery procedures. to review by the receipt of all No later than 3 business Prior authorization is submitting requests necessary days prior to procedure date required for elective online through information. (more, if requested before a procedures subject Web holiday). eQHealth’s to review on HFS system, A reconsideration of eQSuite™. Attachment F that a medical necessity are scheduled on DO NOT send denial may be requests or inquiries and after April 1, requested a) prior to to HFS. 2014. the procedure date and b) requested no later than 10 business days from the date of the denial. IMPORTANT: The prior authorization number (TAN) will be valid for 60 calendar days from the date of the eQHealth approval notice: If a TAN is issued and the admission date changes but remains within those 60 days, the hospital can change the admission date on eQSuite (Utility) or call the eQHealth Helpline with the new admission date. The TAN is still valid.
section of our homepage. Submitting Prior Authorization Requests Prior authorization (PA) review requests are submitted electronically using eQHealth’s proprietary Web-based software, eQSuite™. Thousands of healthcare professionals submit review requests and receive certification responses via the Web. eQHealth’s HIPAA secure, Web-based system – eQSuite ™ provides 24/7 access to: Submit review requests Check status of your Web submitted review Provide additional information when requested by eQHealth Submit online helpline queries View or print provider-specific notification/determination letters Run provider-specific reports with review data For more information on the Web system, see Section V of this manual. Web Administrator The Web Administrator will have rights to create a Provider profile for each user to grant access to eQSuite™ and maintain User IDs and passwords. If the hospital does not currently have a Web Administrator, you must appoint one. Managing system access and users is a non-technical process. A Hospital Contact Form is available on our Website. Review Requests and Determination Timeframes Description Request Method Requirements/Timeframe Determination Mandatory prior authorization of non-emergent, CABG and back surgery procedures. Prior authorization is required for elective procedures subject to review on HFS Attachment F that are scheduled on and after April 1, 2014. The hospital must obtain prior authorization of procedures subject to review by submitting requests online through eQHealth’s Web system, eQSuite™. DO NOT send requests or inquiries to HFS. Requests must be submitted to eQHealth via the Web: Up to 30 calendar days prior to procedure date No later than 3 business days prior to procedure date (more, if requested before a holiday). eQHealth will render a medical necessity determination in 2 business days from the receipt of all necessary information. A reconsideration of a medical necessity denial may be requested a) prior to the procedure date and b) requested no later than 10 business days from the date of the denial. IMPORTANT: The prior authorization number (TAN) will be valid for 60 calendar days from the date of the eQHealth approval notice: If a TAN is issued and the admission date changes but remains within those 60 days, the hospital can change the admission date on eQSuite (Utility) or call the eQHealth Helpline with the new admission date. The TAN is still valid.
Prior%20Auth%20Provider%20Manual%20Rev%201.docx