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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

Clarification for Providers to Alaska Medicaid Recipients
If you are an Idaho provider who provides care for Alaska Medicaid recipients, do not submit these requests through the Qualis Health Provider Portal. Continue to submit them via the iEXCHANGE® web portal until we notify you to do otherwise.

Qualis Health Provider Portal Transition Starts November 1
In November, we are transitioning from iEXCHANGE to the new Qualis Health Provider Portal, a state-of-the-art platform for electronic submission of utilization management (UM) review requests.

Beginning November 1, 2014:

  • Enter new review requests into the Qualis Health Provider Portal
  • Fax concurrent review requests for hospital stays initially entered into iEXCHANGE to Qualis Health at (800) 826-3836
  • Any review requests entered into iEXCHANGE will not be processed


Go to the Qualis Health Provider Portal webpage for more information and resources, including the Qualis Health Provider Portal user guide, training webinar dates and times, and how-to videos.

Attend Qualis Health Provider Portal Training Webinars in November
We are offering Qualis Health Provider Portal training webinars throughout November. You do not need to register in advance for these webinars. Visit the Provider Education page for webinar dates, times and instructions.

Don't forget to complete and submit a Qualis Health Provider Portal registration packet!

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."

January 2014 Provider Manual Online
The January 2014 Provider Manual is now available. Download it now or find it 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

»go to iEXCHANGE®

»go to the 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

»visit the Idaho Medicaid website


»more contact info