advanced diagnostic imaging (adi) july 2015fl.eqhs.com/portals/1/adi ahca approved.pdf · care...
TRANSCRIPT
![Page 1: Advanced Diagnostic Imaging (ADI) July 2015fl.eqhs.com/portals/1/ADI AHCA APPROVED.pdf · Care Administration (AHCA) awarded eQHealth Solutions the contract to provide Comprehensive](https://reader033.vdocuments.mx/reader033/viewer/2022050206/5f59b9cc6e1b173fdc4ad38b/html5/thumbnails/1.jpg)
Advanced Diagnostic Imaging
(ADI)
July 2015
1
![Page 2: Advanced Diagnostic Imaging (ADI) July 2015fl.eqhs.com/portals/1/ADI AHCA APPROVED.pdf · Care Administration (AHCA) awarded eQHealth Solutions the contract to provide Comprehensive](https://reader033.vdocuments.mx/reader033/viewer/2022050206/5f59b9cc6e1b173fdc4ad38b/html5/thumbnails/2.jpg)
Introduction
2
![Page 3: Advanced Diagnostic Imaging (ADI) July 2015fl.eqhs.com/portals/1/ADI AHCA APPROVED.pdf · Care Administration (AHCA) awarded eQHealth Solutions the contract to provide Comprehensive](https://reader033.vdocuments.mx/reader033/viewer/2022050206/5f59b9cc6e1b173fdc4ad38b/html5/thumbnails/3.jpg)
• 2011 Contract award - The Agency for Health
Care Administration (AHCA) awarded
eQHealth Solutions the contract to provide
Comprehensive Medicaid Utilization
Management Services (CMUMP) for the state
of Florida
• Local office / operations in Tampa Bay area
5802 Benjamin Center Drive, Suite 105
Tampa, FL 33634
Partnership: Agency for Health Care
Administration and eQHealth
3
![Page 4: Advanced Diagnostic Imaging (ADI) July 2015fl.eqhs.com/portals/1/ADI AHCA APPROVED.pdf · Care Administration (AHCA) awarded eQHealth Solutions the contract to provide Comprehensive](https://reader033.vdocuments.mx/reader033/viewer/2022050206/5f59b9cc6e1b173fdc4ad38b/html5/thumbnails/4.jpg)
http://fl.eqhs.org
eQHealth Provider Manuals
eQSuite® User Guide
Links to AHCA Handbooks
Forms and Downloads
FAQs
Training Schedules & Registration
Training PowerPoints
Resources
4
![Page 5: Advanced Diagnostic Imaging (ADI) July 2015fl.eqhs.com/portals/1/ADI AHCA APPROVED.pdf · Care Administration (AHCA) awarded eQHealth Solutions the contract to provide Comprehensive](https://reader033.vdocuments.mx/reader033/viewer/2022050206/5f59b9cc6e1b173fdc4ad38b/html5/thumbnails/5.jpg)
Effective August 1, 2015, all Fee-For-Service
(FFS) outpatient advanced diagnostic imaging
(ADI) procedures, including magnetic resonance
imaging (MRI), computerized axial tomography
(CAT or CT), and positron emission tomography
(PET) scans, will require authorization through
eQHealth.
Advanced Diagnostic Imaging
5
![Page 6: Advanced Diagnostic Imaging (ADI) July 2015fl.eqhs.com/portals/1/ADI AHCA APPROVED.pdf · Care Administration (AHCA) awarded eQHealth Solutions the contract to provide Comprehensive](https://reader033.vdocuments.mx/reader033/viewer/2022050206/5f59b9cc6e1b173fdc4ad38b/html5/thumbnails/6.jpg)
AUGUST 1, 2015
MedSolutions will process ADI requests received prior to 8/1/15.
eQHealth begins accepting requests 8/1/15.
Start Date
6
![Page 7: Advanced Diagnostic Imaging (ADI) July 2015fl.eqhs.com/portals/1/ADI AHCA APPROVED.pdf · Care Administration (AHCA) awarded eQHealth Solutions the contract to provide Comprehensive](https://reader033.vdocuments.mx/reader033/viewer/2022050206/5f59b9cc6e1b173fdc4ad38b/html5/thumbnails/7.jpg)
Recipient Requirements
7
Recipients must be:
Enrolled in a Medicaid benefit program that covers the services:
Fee-for-Service;
Dually eligible recipients
Medicare/Medicaid
Commercial/Medicaid
Eligible at the time services are rendered*
*Medically Needy recipients must have active eligibility on the date of service. The date of service and the dates on the PA must be included in the eligibility span.
![Page 8: Advanced Diagnostic Imaging (ADI) July 2015fl.eqhs.com/portals/1/ADI AHCA APPROVED.pdf · Care Administration (AHCA) awarded eQHealth Solutions the contract to provide Comprehensive](https://reader033.vdocuments.mx/reader033/viewer/2022050206/5f59b9cc6e1b173fdc4ad38b/html5/thumbnails/8.jpg)
Requests Not Reviewed by eQHealth
8
Recipients who are:
Members of a Medicaid Managed Medical
Assistance (MMA)
Recipients enrolled in MMA must have
authorization from their managed care plan.
Not Medicaid eligible, but have other coverage for
radiology services through a third party liability
source such as:
Medicare
Commercial insurance
![Page 9: Advanced Diagnostic Imaging (ADI) July 2015fl.eqhs.com/portals/1/ADI AHCA APPROVED.pdf · Care Administration (AHCA) awarded eQHealth Solutions the contract to provide Comprehensive](https://reader033.vdocuments.mx/reader033/viewer/2022050206/5f59b9cc6e1b173fdc4ad38b/html5/thumbnails/9.jpg)
Services provided in the following locations require
authorization:
Outpatient Hospital Departments
Physician Offices
Ambulatory Surgery Centers
Independent Laboratories
Place of Service
9
![Page 10: Advanced Diagnostic Imaging (ADI) July 2015fl.eqhs.com/portals/1/ADI AHCA APPROVED.pdf · Care Administration (AHCA) awarded eQHealth Solutions the contract to provide Comprehensive](https://reader033.vdocuments.mx/reader033/viewer/2022050206/5f59b9cc6e1b173fdc4ad38b/html5/thumbnails/10.jpg)
ADI services do not require authorization if provided
during:
Hospital inpatient stays
23 hour observation
Emergency Department
Place of Service
10
![Page 11: Advanced Diagnostic Imaging (ADI) July 2015fl.eqhs.com/portals/1/ADI AHCA APPROVED.pdf · Care Administration (AHCA) awarded eQHealth Solutions the contract to provide Comprehensive](https://reader033.vdocuments.mx/reader033/viewer/2022050206/5f59b9cc6e1b173fdc4ad38b/html5/thumbnails/11.jpg)
Medical Necessity Criteria
11
![Page 12: Advanced Diagnostic Imaging (ADI) July 2015fl.eqhs.com/portals/1/ADI AHCA APPROVED.pdf · Care Administration (AHCA) awarded eQHealth Solutions the contract to provide Comprehensive](https://reader033.vdocuments.mx/reader033/viewer/2022050206/5f59b9cc6e1b173fdc4ad38b/html5/thumbnails/12.jpg)
Chapter 59G-1.010 (166), Florida Administrative Code:
“Medically necessary” or “medical necessity” means that the medical or allied care, goods, or services furnished or ordered must meet the following conditions:
1. Be necessary to protect life, to prevent significant illness or significant
disability, or to alleviate severe pain;
2. Be individualized, specific, and consistent with symptoms or confirmed
diagnosis of the illness or injury under treatment, and not in excess of
the patient’s needs;
3. Be consistent with generally accepted professional medical standards
as determined by the Medicaid program, and not experimental or
investigational;
4. Be reflective of the level of service that can be safely furnished, and
for which no equally effective and more conservative or less costly
treatment is available statewide; and
5. Be furnished in a manner not primarily intended for the convenience of
the recipient, the recipient's caretaker, or the provider.
Medical Necessity
12
![Page 13: Advanced Diagnostic Imaging (ADI) July 2015fl.eqhs.com/portals/1/ADI AHCA APPROVED.pdf · Care Administration (AHCA) awarded eQHealth Solutions the contract to provide Comprehensive](https://reader033.vdocuments.mx/reader033/viewer/2022050206/5f59b9cc6e1b173fdc4ad38b/html5/thumbnails/13.jpg)
Medicaid reimburses services that:
• Do not duplicate another provider’s service; and
• Are medically necessary for the treatment of a specific documented medical disorder, disease or impairment.
The fact that a provider has prescribed, recommended, or approved medical or allied care, goods, or services does not, in itself, make such care, goods or services medically necessary or a medical necessity or a covered service.
Medical Necessity
13
![Page 14: Advanced Diagnostic Imaging (ADI) July 2015fl.eqhs.com/portals/1/ADI AHCA APPROVED.pdf · Care Administration (AHCA) awarded eQHealth Solutions the contract to provide Comprehensive](https://reader033.vdocuments.mx/reader033/viewer/2022050206/5f59b9cc6e1b173fdc4ad38b/html5/thumbnails/14.jpg)
Codes Requiring Authorization
14
A full list of the ADI codes requiring authorization is posted
on:
http://fl.eqhs.org
Multi-Specialty tab
Forms and Downloads folder
Direct link: http://fl.eqhs.org/LinkClick.aspx?fileticket=lT0AtwYQh0g%3d&tabid=333&mid=942
![Page 15: Advanced Diagnostic Imaging (ADI) July 2015fl.eqhs.com/portals/1/ADI AHCA APPROVED.pdf · Care Administration (AHCA) awarded eQHealth Solutions the contract to provide Comprehensive](https://reader033.vdocuments.mx/reader033/viewer/2022050206/5f59b9cc6e1b173fdc4ad38b/html5/thumbnails/15.jpg)
Review Requests
15
![Page 16: Advanced Diagnostic Imaging (ADI) July 2015fl.eqhs.com/portals/1/ADI AHCA APPROVED.pdf · Care Administration (AHCA) awarded eQHealth Solutions the contract to provide Comprehensive](https://reader033.vdocuments.mx/reader033/viewer/2022050206/5f59b9cc6e1b173fdc4ad38b/html5/thumbnails/16.jpg)
Prior Authorization:
Ordering Provider
M.D./D.O
PA
ARNP
Dentist
Podiatrist
Chiropractor
Retrospective;
Rendering provider
Hospital
ASC
Physician Office
Independent Lab
Reading Radiologist
Review Request Submission
16
![Page 17: Advanced Diagnostic Imaging (ADI) July 2015fl.eqhs.com/portals/1/ADI AHCA APPROVED.pdf · Care Administration (AHCA) awarded eQHealth Solutions the contract to provide Comprehensive](https://reader033.vdocuments.mx/reader033/viewer/2022050206/5f59b9cc6e1b173fdc4ad38b/html5/thumbnails/17.jpg)
Requests may be submitted via fax, using the posted review request form until 10/1/15.
http://fl.eqhs.org, Multi-Specialty/ADI, Forms and Downloads.
Note: There are separate forms for Ultrasound/Bio-Physical Profile (BPP). It is important to use the correct form.
All requests submitted on or after 10/1/15 MUST be submitted via eQSuite®, the online utilization management system.
Exception: Ultrasound/BPP requests continue to be submitted via fax.
Review Requests
17
![Page 18: Advanced Diagnostic Imaging (ADI) July 2015fl.eqhs.com/portals/1/ADI AHCA APPROVED.pdf · Care Administration (AHCA) awarded eQHealth Solutions the contract to provide Comprehensive](https://reader033.vdocuments.mx/reader033/viewer/2022050206/5f59b9cc6e1b173fdc4ad38b/html5/thumbnails/18.jpg)
Initial Request Submission Review Completion Timeframes
Routine requests Prior authorization Timeframe begins upon receipt of all required
documentation
Approved at 1st level/nurse review - within 1
business day
Referral to second level review- within 3
business days
Retrospective Reviews Within one year of the
retroactive eligibility
determination
Within 20 business days
Reconsideration review Within 10 business days of
the denial notice
Within 3 business days of receipt of the request
for reconsideration.
Request Submission & Review
Completion Timeframes
18
![Page 19: Advanced Diagnostic Imaging (ADI) July 2015fl.eqhs.com/portals/1/ADI AHCA APPROVED.pdf · Care Administration (AHCA) awarded eQHealth Solutions the contract to provide Comprehensive](https://reader033.vdocuments.mx/reader033/viewer/2022050206/5f59b9cc6e1b173fdc4ad38b/html5/thumbnails/19.jpg)
Type Method Timeframe
Extension of
authorization time
frame
Providers can extend for an additional
30 days, using the eQSuite® utility.
Only one 30 day extension may be
submitted.
N/A
Change of facility Submit on-line helpline ticket
Call Customer Service
Within 2 business days
Upcoding/downcoding
Modifications to an Existing Review
19
![Page 20: Advanced Diagnostic Imaging (ADI) July 2015fl.eqhs.com/portals/1/ADI AHCA APPROVED.pdf · Care Administration (AHCA) awarded eQHealth Solutions the contract to provide Comprehensive](https://reader033.vdocuments.mx/reader033/viewer/2022050206/5f59b9cc6e1b173fdc4ad38b/html5/thumbnails/20.jpg)
When the prior authorized code
requires….
The following process is followed
Upcoding: e.g. the code for “no contrast” was
originally approved and contrast was used
A new review determination IS required.
The provider will:
o Contact eQHealth’s Customer Service
line or submit an online helpline request
to cancel the existing authorization.
o Enter a new review request with
documentation to substantiate the
medical necessity for the study that was
performed
Downcoding: e.g. the code for “with contrast” was
originally approved and contrast was not used
A new review determination is NOT required.
The provider will:
o Contact eQHealth’s Customer Service
line or submit an online helpline request
to change in the code.
Upcoding/Downcoding
20
![Page 21: Advanced Diagnostic Imaging (ADI) July 2015fl.eqhs.com/portals/1/ADI AHCA APPROVED.pdf · Care Administration (AHCA) awarded eQHealth Solutions the contract to provide Comprehensive](https://reader033.vdocuments.mx/reader033/viewer/2022050206/5f59b9cc6e1b173fdc4ad38b/html5/thumbnails/21.jpg)
Verification that there are no review exclusions:
• Recipient is not eligible for part of the
requested timeframe;
• Duplication of service;
• Requested service is not covered;
• Assessment of the submitted supporting
documentation to ensure it is complete,
legible and conforms to all AHCA policy
requirements.
First Level Review
Screening
21
![Page 22: Advanced Diagnostic Imaging (ADI) July 2015fl.eqhs.com/portals/1/ADI AHCA APPROVED.pdf · Care Administration (AHCA) awarded eQHealth Solutions the contract to provide Comprehensive](https://reader033.vdocuments.mx/reader033/viewer/2022050206/5f59b9cc6e1b173fdc4ad38b/html5/thumbnails/22.jpg)
The clinical reviewer performs the review by applying:
• Definition of medical necessity as stated in Chapter 59G-1.010
(166), Florida Administrative Code (F.A.C.)
• McKesson InterQual
• Agency-approved clinical criteria or guidelines
Resources:
• American College of Radiology: http://www.acr.org/
• ACR Appropriateness Criteria®
• American College of Radiology Practice Parameters
SmartReview algorithms will be loaded in eQSuite® on September 1, 2015
First Level Review
Clinical
22
![Page 23: Advanced Diagnostic Imaging (ADI) July 2015fl.eqhs.com/portals/1/ADI AHCA APPROVED.pdf · Care Administration (AHCA) awarded eQHealth Solutions the contract to provide Comprehensive](https://reader033.vdocuments.mx/reader033/viewer/2022050206/5f59b9cc6e1b173fdc4ad38b/html5/thumbnails/23.jpg)
First Level Reviewers may:
• Approve the services as requested;
• Pend the request for additional information from the provider;
• Refer the request to a physician peer reviewer for review and
determination; or
• Cancel or issue a technical denial of the request if appropriate,
e.g.:
• Duplicative service;
• Noncompliance with AHCA policy.
First Level Review Determinations
23
![Page 24: Advanced Diagnostic Imaging (ADI) July 2015fl.eqhs.com/portals/1/ADI AHCA APPROVED.pdf · Care Administration (AHCA) awarded eQHealth Solutions the contract to provide Comprehensive](https://reader033.vdocuments.mx/reader033/viewer/2022050206/5f59b9cc6e1b173fdc4ad38b/html5/thumbnails/24.jpg)
• Physician peer reviewers base their determination
on generally accepted professional standards of
care, on their clinical experience and judgment and
peer to peer consultation with the ordering
physician.
• Physician reviewers may render an approval or an
adverse determination.
• An adverse determination may be a full denial of
the requested services or a reduction in services.
Second Level Review
24
![Page 25: Advanced Diagnostic Imaging (ADI) July 2015fl.eqhs.com/portals/1/ADI AHCA APPROVED.pdf · Care Administration (AHCA) awarded eQHealth Solutions the contract to provide Comprehensive](https://reader033.vdocuments.mx/reader033/viewer/2022050206/5f59b9cc6e1b173fdc4ad38b/html5/thumbnails/25.jpg)
Determination notifications are issued within one business day of the determination.
• An electronic advisory message is immediately issued for the requesting provider.
• A written notification of the determination is posted on eQSuite®.
• Determination specifies the approved code(s) and the duration (from and through dates).
• Notifications may be downloaded and printed.
• The recipient or legal guardian receives written, mailed notification.
Review Determination Notification
25
![Page 26: Advanced Diagnostic Imaging (ADI) July 2015fl.eqhs.com/portals/1/ADI AHCA APPROVED.pdf · Care Administration (AHCA) awarded eQHealth Solutions the contract to provide Comprehensive](https://reader033.vdocuments.mx/reader033/viewer/2022050206/5f59b9cc6e1b173fdc4ad38b/html5/thumbnails/26.jpg)
Notifications include:
• Service(s) approved or denied;
• Dates of service(s) approved;
• Reason for an adverse decision;
• Rights to a reconsideration and how to request
one; and
• Recipient’s right to a fair hearing and how the
recipient may request one.
Review Determination Notification
26
![Page 27: Advanced Diagnostic Imaging (ADI) July 2015fl.eqhs.com/portals/1/ADI AHCA APPROVED.pdf · Care Administration (AHCA) awarded eQHealth Solutions the contract to provide Comprehensive](https://reader033.vdocuments.mx/reader033/viewer/2022050206/5f59b9cc6e1b173fdc4ad38b/html5/thumbnails/27.jpg)
Any party may request a reconsideration of an
adverse determination by:
• eQSuite® (electronic)
• Phone
• Fax
Reconsiderations
27
![Page 28: Advanced Diagnostic Imaging (ADI) July 2015fl.eqhs.com/portals/1/ADI AHCA APPROVED.pdf · Care Administration (AHCA) awarded eQHealth Solutions the contract to provide Comprehensive](https://reader033.vdocuments.mx/reader033/viewer/2022050206/5f59b9cc6e1b173fdc4ad38b/html5/thumbnails/28.jpg)
A physician reviewer not involved in the original
adverse determination will render one of the following: • Uphold the original adverse determination;
• Modify the original determination, approving a portion
of the service requested; or
• Reverse the original determination, approving
services requested.
Reconsideration reviews are completed within three
business days of receipt of a complete and valid
request.
Please Note: When requesting a reconsideration, new and/or additional clinical information should be submitted.
Reconsiderations
28
![Page 29: Advanced Diagnostic Imaging (ADI) July 2015fl.eqhs.com/portals/1/ADI AHCA APPROVED.pdf · Care Administration (AHCA) awarded eQHealth Solutions the contract to provide Comprehensive](https://reader033.vdocuments.mx/reader033/viewer/2022050206/5f59b9cc6e1b173fdc4ad38b/html5/thumbnails/29.jpg)
Recipients, or their legal representatives, may appeal an
adverse decision by requesting a fair hearing.
The appeal must be submitted:
• By written statement to AHCA Medicaid Area Office;
and
• Within 90 calendar days of the date of the adverse
determination notification mailing.
Fair Hearings
29
![Page 30: Advanced Diagnostic Imaging (ADI) July 2015fl.eqhs.com/portals/1/ADI AHCA APPROVED.pdf · Care Administration (AHCA) awarded eQHealth Solutions the contract to provide Comprehensive](https://reader033.vdocuments.mx/reader033/viewer/2022050206/5f59b9cc6e1b173fdc4ad38b/html5/thumbnails/30.jpg)
Supporting documentation is determined by
AHCA policy and is required to substantiate the
necessity of services.
The ordering physician prescription is required
when the request is submitted by the facility or
the reading radiologist.
If additional supporting documentation is
required, the requesting provider will be notified
via an eQSuite® pend.
Required Supporting Documentation
30
![Page 31: Advanced Diagnostic Imaging (ADI) July 2015fl.eqhs.com/portals/1/ADI AHCA APPROVED.pdf · Care Administration (AHCA) awarded eQHealth Solutions the contract to provide Comprehensive](https://reader033.vdocuments.mx/reader033/viewer/2022050206/5f59b9cc6e1b173fdc4ad38b/html5/thumbnails/31.jpg)
Options for submitting documentation:
1. Upload and directly link the information to the
eQSuite® review record.
2. Download eQHealth bar coded fax covered
sheet(s) from http://fl.eqhs.org and submit the
information using our 24/7 toll free fax line
855-440-3747.
3. Attach documentation to the faxed request
form (for requests submitted prior to 10/1/15)
Submitting Supporting
Documentation
31
![Page 32: Advanced Diagnostic Imaging (ADI) July 2015fl.eqhs.com/portals/1/ADI AHCA APPROVED.pdf · Care Administration (AHCA) awarded eQHealth Solutions the contract to provide Comprehensive](https://reader033.vdocuments.mx/reader033/viewer/2022050206/5f59b9cc6e1b173fdc4ad38b/html5/thumbnails/32.jpg)
Each fax cover sheet includes a bar code that is specific to the particular recipient and the type of required information.
The review-specific fax cover sheets are available for downloading and printing as soon as the review request is completed and entered into eQSuite®.
You must use only the assigned fax cover sheet for the specific type of supporting documentation.
Do not copy or reuse fax cover sheets!
Submitting Supporting
Documentation
32
![Page 33: Advanced Diagnostic Imaging (ADI) July 2015fl.eqhs.com/portals/1/ADI AHCA APPROVED.pdf · Care Administration (AHCA) awarded eQHealth Solutions the contract to provide Comprehensive](https://reader033.vdocuments.mx/reader033/viewer/2022050206/5f59b9cc6e1b173fdc4ad38b/html5/thumbnails/33.jpg)
eQSuite®
33
![Page 34: Advanced Diagnostic Imaging (ADI) July 2015fl.eqhs.com/portals/1/ADI AHCA APPROVED.pdf · Care Administration (AHCA) awarded eQHealth Solutions the contract to provide Comprehensive](https://reader033.vdocuments.mx/reader033/viewer/2022050206/5f59b9cc6e1b173fdc4ad38b/html5/thumbnails/34.jpg)
Proprietary eQHealth web-based software:
• Secure HIPAA-compliant technology allows
providers to record and transmit information
necessary to obtain authorizations.
eQSuite®
34
![Page 35: Advanced Diagnostic Imaging (ADI) July 2015fl.eqhs.com/portals/1/ADI AHCA APPROVED.pdf · Care Administration (AHCA) awarded eQHealth Solutions the contract to provide Comprehensive](https://reader033.vdocuments.mx/reader033/viewer/2022050206/5f59b9cc6e1b173fdc4ad38b/html5/thumbnails/35.jpg)
Minimal Computer System Requirements:
• Intel Pentium 4 or higher CPU and monitor
• Windows XP SP2 or higher
• 1 GB free hard drive space
• 512 MB memory
• Internet Explorer 9 or higher, Mozilla Firefox
35 or higher, or Safari 6 or higher
• Broadband internet connection
eQSuite ®
35
![Page 36: Advanced Diagnostic Imaging (ADI) July 2015fl.eqhs.com/portals/1/ADI AHCA APPROVED.pdf · Care Administration (AHCA) awarded eQHealth Solutions the contract to provide Comprehensive](https://reader033.vdocuments.mx/reader033/viewer/2022050206/5f59b9cc6e1b173fdc4ad38b/html5/thumbnails/36.jpg)
• Create new reviews
• Respond to requests for additional information
• Submit documentation
• Respond to adverse determinations
• Search for authorization requests/reviews
• View and download reports and letters
• Online Helpline
• Control system access
• Update user profiles
eQSuite® Functions
36
![Page 37: Advanced Diagnostic Imaging (ADI) July 2015fl.eqhs.com/portals/1/ADI AHCA APPROVED.pdf · Care Administration (AHCA) awarded eQHealth Solutions the contract to provide Comprehensive](https://reader033.vdocuments.mx/reader033/viewer/2022050206/5f59b9cc6e1b173fdc4ad38b/html5/thumbnails/37.jpg)
Live Demonstration
eQSuite®
37
![Page 38: Advanced Diagnostic Imaging (ADI) July 2015fl.eqhs.com/portals/1/ADI AHCA APPROVED.pdf · Care Administration (AHCA) awarded eQHealth Solutions the contract to provide Comprehensive](https://reader033.vdocuments.mx/reader033/viewer/2022050206/5f59b9cc6e1b173fdc4ad38b/html5/thumbnails/38.jpg)
1. Complete the Provider Contact Form;
2. Assign logons to staff.
Getting Started
38
![Page 39: Advanced Diagnostic Imaging (ADI) July 2015fl.eqhs.com/portals/1/ADI AHCA APPROVED.pdf · Care Administration (AHCA) awarded eQHealth Solutions the contract to provide Comprehensive](https://reader033.vdocuments.mx/reader033/viewer/2022050206/5f59b9cc6e1b173fdc4ad38b/html5/thumbnails/39.jpg)
Provider Outreach, Education
and Technical Assistance
39
![Page 40: Advanced Diagnostic Imaging (ADI) July 2015fl.eqhs.com/portals/1/ADI AHCA APPROVED.pdf · Care Administration (AHCA) awarded eQHealth Solutions the contract to provide Comprehensive](https://reader033.vdocuments.mx/reader033/viewer/2022050206/5f59b9cc6e1b173fdc4ad38b/html5/thumbnails/40.jpg)
• Provider Outreach and Education
• Customer Service Representatives
1-855-444-3747
8 a.m. – 5 p.m. Eastern Time
Monday – Friday
(except recognized Florida state holidays)
Provider Education & Outreach Team
40
![Page 41: Advanced Diagnostic Imaging (ADI) July 2015fl.eqhs.com/portals/1/ADI AHCA APPROVED.pdf · Care Administration (AHCA) awarded eQHealth Solutions the contract to provide Comprehensive](https://reader033.vdocuments.mx/reader033/viewer/2022050206/5f59b9cc6e1b173fdc4ad38b/html5/thumbnails/41.jpg)
Dedicated Florida Provider Website
http://fl.eqhs.org
Blast email distribution list
Send request to [email protected]
Include email address and “ADI” in the
body of the email.
Provider Communications
41
![Page 42: Advanced Diagnostic Imaging (ADI) July 2015fl.eqhs.com/portals/1/ADI AHCA APPROVED.pdf · Care Administration (AHCA) awarded eQHealth Solutions the contract to provide Comprehensive](https://reader033.vdocuments.mx/reader033/viewer/2022050206/5f59b9cc6e1b173fdc4ad38b/html5/thumbnails/42.jpg)
Transition
42
MedSolutions is responsible for all Fair
Hearings for adverse determinations
made by MedSolutions.
eQHealth is responsible for all revisions,
corrections and modifications to
MedSolutions’ reviews.
For reconsideration of MedSolutions’
adverse determinations, submit a new
authorization request to eQHealth.
![Page 43: Advanced Diagnostic Imaging (ADI) July 2015fl.eqhs.com/portals/1/ADI AHCA APPROVED.pdf · Care Administration (AHCA) awarded eQHealth Solutions the contract to provide Comprehensive](https://reader033.vdocuments.mx/reader033/viewer/2022050206/5f59b9cc6e1b173fdc4ad38b/html5/thumbnails/43.jpg)
Questions and Answers
43