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Advancing Healthcare Improving Health
How to Register for the Qualis Health Provider Portal
for Wyoming Medicaid
Teresa Kirn, RN IQCI Clinical Nurse Specialist
March 6, 2019 and March 7, 2019
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Advancing Healthcare Improving Health
One of the nation’s leading healthcare consulting organizations, partnering with our clients across the country to improve care for millions of Americans every day www.qualishealth.org
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Qualis Health • A private nonprofit organization
established in 1974
• Corporate Office located in Seattle, Washington with regional offices in Alabama, Alaska, District of Columbia, Idaho, Kansas, and New Mexico
• Have provided care management to Medicaid and Private contracts since 1984
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Qualis Health & HealthInsight have joined forces to do great things.
Together, we’re reimagining health care.
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What We Do • Contract with Wyoming Medicaid to review for select
outpatient services: – Durable Medical Equipment (DME) – Home Health Services (HHS) – Physical Therapy (PT), Occupational Therapy (OT), Speech Therapy
(ST) and Behavioral Health (BH) visits. – Skilled Nursing (SN) reviewers for waiver plans – April 1, 2019
• We will use InterQual® (IQ) and organizational policies to
conduct our review
• Offer telephonic provider education
• Provider review support resource accessibility on our webpage
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What We Don’t Do
We do not receive financial incentives to deny or limit services
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Objectives
• How to register for the Qualis Health Provider Portal (QHPP)
• Review upcoming training sessions specifically for Skilled Nursing (SN) for waiver programs.
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How to Get Started • Go to http:www.qualishealth.org • At top of the page hover over
‘Healthcare Professionals’ and choose ‘Wyoming Medicaid’
• Left side navigational panel: select ‘Provider Resources’
• Scroll to middle of ‘Provider Resources’ page to download the registration packet
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9 http://www.qualishealth.org/healthcare-professionals/wyoming-medicaid
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What to return to Qualis Health • Executive Agreement
• Provider Portal Administration Agreement
• Provider Portal Administration Registration Form
After Qualis Health processes your registration packet, you will receive an email with your QHPP access information.
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Where to Send your Packet Submit via:
• Email: [email protected] and [email protected]
or • Fax: 206-288-2356 (1-877-523-1148)
or • Mail: Qualis Health
Attn: WY Medicaid PO Box 33400 Seattle, WA 98133
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To Launch the QHPP
http://www.qualishealth.org/sites/default/files/WY-Medicaid-QHPP-User-Guide.pdf
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Lost Password • Qualis Health Provider Portal enables users to reset their user password
by answering a predefined password reset question. This password reset question is created in Edit My Profile. If you have not created a password reset question and answer in your Profile page, you will not be able to generate a new password yourself.
• In this case, you will need to ask your Provider Portal Administrator to reset your password for you.
• If you are the Provider Portal Administrator and you need your password reset, please email Qualis Health: [email protected] and [email protected].
• In the case of lost password or to reset your password, in the Qualis Health Provider Login screen, click the Forgot Password link. This displays the Login Details screen.
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Training WebEx Schedule Date Time (MST) Training Topic
3/6/2019 2-3pm How to register for the QHPP. All sessions will be recorded and available under WY Medicaid Resources at Qualishealth.org
3/7/2019 9:30-10:30am How to register for the QHPP (Repeat of 3/6/2019 afternoon session)
3/12/2019 3-4pm Provider Review Request for Skilled Nursing services for waiver plans
3/13/2019 9:30-10:30am Provider Review Request for Skilled Nursing for waiver plans (Repeat of 3/12/2019 afternoon session)
4/3/2019 2-3pm Question and Answer session after 4/1/2019 go live
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Qualis Health Contact Information Qualis Health
Phone: (800) 783-8606 Fax: (877) 810-9255
Teresa Kirn RN, IQCI Clinical Nurse Specialist (208) 383-5960 [email protected] Deon Westmorland RN BSN CCM Associate Vice President Wyoming Medicaid Services (206) 288-2347 [email protected]
Lisa Layne Non-Clinical Manager (206) 288-2385 [email protected]
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Qualis Health Contact Information Utilization Review Toll-free Phone
(800) 783-8606 Toll-free Fax
(877) 810-9265
Utilization Review Hours 8:30am to 7:00pm MST Monday through Friday
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Qualis Health Provider Portal
Questions?