Provider Resources

OneHealthPort/iEXCHANGE® sign-on is contract specific. Please make sure your OneHealthPort account is updated to allow you to submit reviews for Washington Medicaid.

Once your OneHealthPort account is updated to include Washington Medicaid, you will receive an email from Qualis Health that includes directions on how to notify us of your submitting providers.

Visit the OneHealthPort registration page

Frequently Asked Questions

• Advanced Imaging Prior Authorization through Qualis Health FAQs

CPT Codes for Review

• Advanced Imaging Procedure List (effective September 15, 2011)
• Surgical Procedure List (effective 4/1/12 for dates of service on or after 4/15/12)

Guides

• Physician/Practitioner Guide to Submitting Imaging Requests for Washington Medicaid Patients

Provider Memos

• Provider Memo 11-50 (August 2011)

Forms

Request for Review

• Advanced Imaging Request for Review (March 2012)
• Surgical Procedure Request for Review (effective 4/1/12 for dates of service on or after 4/15/12)

CarePlanner/iEXCHANGE Imaging Questionnaires

• Brain PET Scan (October 21, 2011)
• Breast MRI (October 21, 2011)
• Cardiac (October 21, 2011)
• Cervical Spine (October 21, 2011)
• CT Abdomen (November 10, 2011)
• CT Abdomen and Pelvis (October 21, 2011)
• CT Pelvis (October 21, 2011)
• Headache (October 21, 2011)
• Lower Extremity (October 21, 2011)
• Lumbar Spine (October 21, 2011)
• PET/CT Scan and PET Scan (October 21, 2011)
• Upper Extremity (October 21, 2011)

Evidence-based Imaging Guidelines

Do not submit these with requests. Please use the questionnaires above.

• Cervical Spine
• Headache
• Lower Extremity
• Lumbar Spine
• Thoracic Spine
• Upper Extremity

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