Provider Resources

Go to: Qualis Health Provider Portal | Provider Notices | Provider Manual & Appendices | Checklists & Forms | Presentation Slides

Qualis Health Provider Portal

The Qualis Health Provider Portal is a web-based application that allows you to submit requests for authorization via the internet.

Go to the Qualis Health Provider Portal

Register for the Qualis Health Provider Portal

1. Download the Qualis Health Provider Portal registration packet.
2. Complete the following forms (in the packet) and send them to Qualis Health:
   • Executive Agreement
   • Provider Portal Administrator Agreement
   • Provider Portal Administrator Registration
3. We will set up your account and email login information to you.

Qualis Health Provider Portal Resources

• Training Videos
  • Registering
  • Logging In and Getting Started
  • Submitting New Requests
  • Searching for Requests
  • Administrator Tasks
     
• User Guide (August 25, 2016)
   
• Administrator Guide (August 15, 2017)

Provider Notices

• Qualis Health Name Change
• DC Medicaid Transmittal 17-09: Out-of-State Nursing Facility Placement and Review Procedures
• Eligibility for Medicaid Long Term Care Nursing Facility Services

Provider Manual & Appendices

• DC Medicaid Provider Manual
• 719A: Prior Authorization Request Form
• 1728: Intermediate Care Facility / Nursing Facility Level of Care Form
• Cone Beam Computed Tomography in Endodontics - AAE and AAOMR Joint Position Statement
• Dental Utilization Review Criteria Guidelines
• Time Spans for Prior Authorizations and Approval Letters

Checklists & Forms

• DME, Vision and Hearing Service Providers Services Checklist
• EPD Waiver Services Checklist
• Hospice Election and Physician Certification Form
• Hospice Termination Form
• ICF/IID Recertification Checklist and Forms
• LTAC/Rehab/SNF: Info Needed for Pre-admission or Admission Review

Presentation Slides

• Inpatient Hospice Training (January 23, 2018)

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