Provider Resources

Go to: Comagine Health Provider Portal | CPT Codes for Review | Request Forms | Questionnaires | Other Resources

March 19, 2020: COVID-19 and Business Continuity

During the current COVID-19 emergency, Comagine Health is fully staffed and business operations are not interrupted.

For utilization review, case management and related activities, we are continuing to process requests and answer calls via our toll-free numbers during standard business hours. We have business continuity plans in place to serve our clients, health care providers, patients and communities while also protecting our staff and minimizing the spread of the illness.

Qualis Health Provider Portal

The Qualis Health Provider Portal is a web-based application that allows you to submit utilization management (UM) review requests via the internet. Washington state providers access the Qualis Health Provider Portal through OneHealthPort.

Go OneHealthPort / Comagine Health Provider Portal

Beginning January 1, 2017, providers located in Washington state must use the Qualis Health Provider Portal to submit requests for imaging, spinal injections and therapy services (PT, OT, WC).

View the announcement flyer for more information

In order to submit requests via the Qualis Health Provider Portal, your organization must be registered with both OneHealthPort and the Qualis Health Provider Portal.

• Instructions for registering with OneHealthPort and the Qualis Health Provider Portal
• Instructions for accessing the Qualis Health Provider Portal via OneHealthPort

CPT Codes for Review

• Advanced Imaging Procedure List
• Spinal Injection CPT Code List

Request Forms

• Advanced Imaging Request for Review Form
• Group A Provider Outpatient Procedure Notification Form
• Physical Medicine Request for Review Form
• Spinal Injection Request for Review Form
• Surgical Request for Review Form

Questionnaires

Advanced Imaging

• Brain Imaging Questionnaire
• Cardiac Imaging Questionnaire
• Cervical Spine MRI Questionnaire
• Lower Extremity MRI Questionnaire
• Lumbar Spine MRI Questionnaire
• Non-Joint Extremity MRI Questionnaire
• Thoracic Spine MRI Questionnaire
• Upper Extremity MRI Questionnaire

Physical Medicine

• Physical/Occupational Therapy Questionnaire
• Work Conditioning Questionnaire

Spinal Injection

• Diagnostic Facet Injections and Medial Branch Blocks Questionnaire
• Sacroiliac Joint Injections Questionnaire
• Therapeutic Epidural Injections Questionnaire

Other Resources

General

• Helpful Links
• Information About HIPAA and L&I
• Determining Specific Code Prior Authorization Requirements on the Washington L&I Website

Advanced Imaging Utilization Review

• Evidence-Based Imaging Guidelines
  • Cervical Spine
  • Headache
  • Lower Extremity
  • Lumbar Spine MRI
  • Thoracic Spine
  • Upper Extremity

Inpatient/Outpatient Utilization Review

All inpatient services require utilization review through Qualis Health.

Spinal Injection Utilization Review

• Medical Treatment Guidelines

Go to: Comagine Health Provider Portal | CPT Codes for Review | Request Forms | Questionnaires | Other Resources | Top of 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.