Text Size

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

Select Diagoses/Procedures Review Guidelines Updated for 2016
The Select Diagnoses/Procedures Review Guidelines have been updated and are effective January 1, 2016. You can also find this document on the Provider Resources page.

Qualis Health Provider Portal User Guide Updated
January 22, 2016: The Qualis Health Provider Portal User Guide has been updated. You can also find it on the Provider Resources page.

Provider Manual Updated Effective October 1
The Idaho Medicaid Provider Manual has been revised and is effective October 1, 2015. You can also it on the Provider Resources page.

Get Ready for ICD-10 with New Select Diagnoses/Procedures Review Guidelines
We have posted new Select Diagnoses/Procedures Review Guidelines that include CPT and ICD-10. Use these guidelines for dates of service beginning October 1, 2015. Do not use this list for dates of service before October 1.

For dates of service through September 30, 2015, continue using the current Select Diagnoses/Procedures Review Guidelines that include CPT and ICD-9 (also known as Provider Manual Appendix A).

You can find both of these documents 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