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

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

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

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: jorgw@qualishealth.org and lisal@qualishealth.org

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: jorgw@qualishealth.org and lisal@qualishealth.org.

• 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 teresak@qualishealth.org Deon Westmorland RN BSN CCM Associate Vice President Wyoming Medicaid Services (206) 288-2347 deonw@qualishealth.org

Lisa Layne Non-Clinical Manager (206) 288-2385 lisal@qualishealth.org

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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?