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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


More Qualis Health Provider Portal Training Webinars in February and March
If you haven't yet attended a Qualis Health Provider Portal training webinar, it isn't too late. We are holding more sessions in February and March. It only takes an hour, and you don't need to sign up in advance. Go to the Provider Education page for webinar dates, times and instructions.

Revised Provider Manual Effective January 1
The Idaho Medicaid Provider Manual has been revised and is effective January 1, 2015. It includes updated Select Diagnoses/Procedures Review Guidelines. You can also find these documents 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.

LTAC, Rehab, SNF Pre-admission/Admission Review Info Sheet
June 16: A new info sheet lists the information we need from you for LTAC, rehab and SNF pre-admission or admission review. You can also find it on the Provider Resources page under "Other Resources."



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Contact Us

Initiate a Review

»Qualis Health Provider Portal

(800) 826-3836

(800) 783-9207

Physician Hotline

(877) 292-2615

Contact Idaho Medicaid

Dori Boyle
Medical Program Specialist
(208) 364-1835

»Idaho Medicaid website

»more contact info