Hours of operation are 8:00am to 8:00pm (ET) Monday to Friday, excluding holidays. Submit Prior Authorization by Fax : (586) 693-4829 Prior authorization is not required for emergency or observation services, however, authorization is required within 2 business days from the inpatient facility if the member is admitted as a result of emergency or observation services.įor questions on how to submit a prior authorization request or to check the status of a request that has previously been submitted, please contact eQHealth customer service at (866) 356-3666.įor questions regarding benefits, eligibility and the list of services that require prior authorization, please call the customer service number located on the back of the member ID card. Submitting requests without all relevant supporting documentation will result in longer processing times or the inability to process the request. Processing times for prior authorization requests are based on the receipt of all required and relevant supporting documentation. eQHealth adheres to the timelines developed by URAC (Utilization Review Accreditation Commission and NCQA (National Committee on Quality Assurance) in responding to utilization management requests. Utilization management decisions are made in a timely manner to accommodate the clinical urgency of the request. Clinical documentation relevant to the request such as signs, symptoms, history, diagnostic tests results, consultant recommendations (if applicable) and plan of treatment.ĭownload the Prior Authorization Request Form.Please submit the following information when requesting prior authorization: Please check to ensure a service requires prior authorization before submitting a second request. If a request is submitted for services that do not require prior authorization, a response will be sent back to notify the requestor that prior authorization is not required for that service. For a comprehensive list of procedures with the ICD-10 or CPT codes, please refer to the 2020 Services Requiring Prior Authorization List posted on the USHL website. Providers must obtain prior authorization from eQHealth before the admission or services are provided. Certain outpatient surgeries, treatments, services, medications and durable medical equipment.All inpatient admissions to any acute care facility require prior authorization and concurrent review.US Health and Life requires prior authorization of certain services including: Box 37504, Oak Park, MI 48237.We are pleased to announce a new partnership with eQHealth Solutions to provide utilization management services effective Jan. Paper claims should be submitted to USHL, P.O. UB-92 (institutional) and CMS-1500 (professional) paper forms are accepted for processing. Paper Claim SubmissionĪlthough paper claim submission is not recommended, providers having only this capability can arrange such submission by contacting ABS EDI Support. This method of claims submission is not recommended however If you choose this method, you must contact ABS EDI Support for proper implementation of FTP protocols. Wagner paramilitary group won’t surrender to demands from Russian President Vladimir Putin or the security services, Yevgeniy Prigozhin, Wagner’s owner, says in audio message in his Telegram. Contact ABS EDI Support for portal access instructions. Trading partners transmitting claim volumes in excess of 200 claims daily should utilize the ABS RelayHealth PCS Portal. Contact RelayHealth (at the number above) or your clearinghouse regarding this relationship. Providers working with a clearinghouse other than RelayHealth may continue to work with their current vendor, assuming that vendor can push files to RelayHealth. A secure link to the provider office must be established – contact RelayHealth at 80, Option 2 or go to Alternate Clearinghouses Once claims are processed, providers can choose to receive explanation of benefits (EOBs) in either electronic (EDI X 12) or paper form.Īvailable claim submission options: RelayHealthĬlaims can be processed directly through ABS’s contracted clearinghouse, RelayHealth. Individual claims can be wrapped in their own GE/GS envelope.Each file can contain more that one GE/GS envelope.ABS requests that files be submitted with no greater that 500 claims per file. Information on formatting can be found at.We verify all inbound x12 file to WEDI SNIP Level2. ABS processes ANSI X12 837 institutional professional files.
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