Qualis Health has partnered with Washington State Medicaid to provide utilization review services for their enrolled residents. We look forward to serving the people of Washington in collaboration with the state and providers. We are privileged to perform this vital work.
Services We Provide for Washington State Medicaid
Utilization review is conducted on a prospective and/or retrospective basis for specified advanced imaging studies and select surgical procedures.
- Beginning September 16, 2013, Qualis Health will perform medical necessity reviews for select spinal injection procedures with dates of service on or after October 1, 2013. To learn more about this new rule, please read Provider Notices 13-39 and 13-47 at http://www.hca.wa.gov/medicaid/billing/pages/year2013email.aspx.
Requests for authorization will be submitted through our web-based utilization review system, iEXCHANGE®. If you have an iEXCHANGE account for Washington Medicaid, you do not need to re-register. If you need to create an iEXCHANGE account or add submitting providers to your existing account, go to http://www.onehealthport.com/services/Qualis.php and follow the instructions.
You'll find criteria and forms on our Provider Resources page and the iEXCHANGE training manual on our Provider Education page.
- Beginning April 1, 2012, Qualis Health will be providing surgical review services for Washington Medicaid.
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