This revised Provider Manual was prepared for the Idaho Department of Health and Welfare by Qualis Health in February 2006 and will be updated periodically.
Idaho Medicaid Provider Manual — Effective January 1, 2010
The purpose of this manual is to provide information to providers regarding the Medicaid Review Programs for Idaho Medicaid clients. The following is a list of the chapters:
- Section I: Purpose of the Qualis Health Care Management Program
- Section II: Communicating with Qualis Health
- Section III: Categories of Eligibility
- Section IV: Review Considerations
- Section V: Web-Based Utilization Review (iEXCHANGE®)
- Section VI: Pre-service Review
- Section VII: Concurrent Review
- Section VIII: Late Certification Reviews
- Section IX: Psychiatric and Chemical Dependency Review
- Section X: Physical Rehabilitation Review
- Section XI: Retrospective Review - Retroactive Eligibility
- Section XII: Retrospective Review (“Late” Review)
- Section XIII: Quality of Care Reviews
- Section XIV: Focused Case Reviews
- Section XV: Appeal Procedure
- Section XVI: Frequently Asked Questions
- Section XVII: Case Management
- Appendix A: Select Pre–Authorization List of Diagnoses and Procedures
- Appendix B: Glossary
- Appendix C: Key Contact Personnel
- Appendix D: Provider Bulletins/Informational Release
- Appendix E: Exhibits
