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Idaho Department of Health and Welfare, Division of Medicaid


Qualis Health provides case management and utilization management services to the Idaho Department of Health and Welfare, Division of Medicaid. We are staffed by qualified healthcare professionals who provide services tailored to the needs of enrolled Idaho residents.


Who We Serve

The Idaho Medicaid program provides healthcare for eligible elderly and disabled individuals and eligible low-income pregnant women, children and parents. In support of the Medicaid program, we currently serve more than 240,000 Medicaid clients in Idaho. We are privileged to be instrumental in this vital work.


Services We Provide for Idaho Medicaid

  • Utilization management
    • Pre-admission review
    • Concurrent review
    • Retrospective review
    • Appeals
  • Case management
  • Focused case review
  • Provider education sessions


Announcements

Revised Provider Manual Available
The Idaho Medicaid Provider Manual has been revised and is effective July 1, 2015. It includes updated Select Diagnoses/Procedures Review Guidelines. You can also find these documents on the Provider Resources page.

Two Qualis Health Provider Portal Training Webinars in June
We are holding two Qualis Health Provider Portal training webinars in June. Webinars are one hour long, and you don't need to sign up in advance. Visit the Provider Education page for dates, times and instructions.

Qualis Health Provider Portal User Guide Updated
March 23, 2015: The Qualis Health Provider Portal User Guide has been updated. You can also find it on the Provider Resources page.

Qualis Health Provider Portal Transition Completed
In November we transitioned from iEXCHANGE to the Qualis Health Provider Portal.

As of November 1, 2014:

  • Enter review requests into the Qualis Health Provider Portal
  • Any review requests entered into iEXCHANGE will not be processed


You'll find more information, including how-to videos and the Qualis Health Provider Portal User Guide, on the Provider Resources page.

 

 

Adobe Acrobat® PDF files can be opened using Adobe Acrobat Reader. If you do not have Reader, you can get it FREE from the Adobe website.

Contact Us

Initiate a Review

»Qualis Health Provider Portal

Fax:
(800) 826-3836

Phone:
(800) 783-9207

Physician Hotline

(877) 292-2615

Contact Idaho Medicaid

Dori Boyle
Medical Program Specialist
(208) 364-1835
boyled@dhw.idaho.gov

»Idaho Medicaid website


»more contact info