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 190,000 Medicaid clients in Idaho. We are privileged to be instrumental in this vital work.

Services We Provide for Idaho Medicaid

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

Announcements

• The 2013 Annual Patient Safety and Quality Improvement Conference will be held April 4-5. Learn more about the conference or register online now.
• Effective January 1, 2013, a complete medical record is no longer required to conduct a retrospective review for a hospital stay longer than 15 days. If possible, please submit your review through iEXCHANGE®, Qualis Health's web-based review tool.

Please use the following process:

1. Review patient history and physical

2. Provide brief summary, with dates, of the reason for admission (no longer than a few sentences)

3. Review doctor’s orders and progress notes

4. Provide brief summary, with dates, for each seven-day period of the patient’s stay (no longer than a few sentences)

5. Review and provide lab, x-ray, diagnostic testing and other information related to the patient’s admission/continued stay

6. Review discharge summary and provide discharge plan

If iEXCHANGE is unavailable, you may submit the above information via fax to (800) 826-3836.

If you have questions or concerns, please contact Deon Westmorland, Director, Alaska and Idaho Medicaid Services at (206) 288-2347 or deonw@qualishealth.org.
 

• The January 2013 Provider Manual is now available. Download it now or find it on the Provider Resources page.
• Provider Bulletin: Surgical Reviews (June 21, 2011)
   

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