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Prior Authorization. The Agency for Health Care Administration has contracted with a certified Quality Improvement Organization (QIO), eQHealth Solutions, Inc. to provide medical necessity reviews for Medicaid home health services. For more information on eQHealth Solutions, Inc. please visit the website.
Please call our Provider Services help line at 1-844-477-8313 to check if a prior authorization is required or use our online prior authorization look up tool. Services Requiring Prior Authorization. PCPs, Specialists, or Facilities must request an authorization for the following services. Expand the links below to find out more information.
Provider Enrollment is responsible for enrolling qualified providers to receive Medicaid reimbursement for services rendered to Medicaid Fee-For-Service recipients. Florida Medicaid's Web Portal solution provides communication and self-service tools to the provider community.
Medicaid is a medical assistance program that provides access to health care for low-income families and individuals. Medicaid also assists the elderly and people with disabilities with the costs of nursing facility care and other medical and long-term care expenses.
Prior authorization (PA) is required for some out-of-network providers, outpatient care and planned hospital admissions. We don’t require PA for emergency care. You can find a current list of the services that need PA on the Provider Portal. You can also find out if a service needs PA by using ProPAT, our online prior authorization search tool.
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Prior Authorization Lookup Tool. To find out if a service needs prior authorization, please enter a CPT code or an HCPCS code in the space below to get started. If an authorization is required, you can access NaviNet and submit electronically (PDF).
If you have any questions about authorization requirements or need help with the search tool, contact Aetna Better Health of Florida Provider Relations at 1-800-441-5501 for Medicaid and 1- 844-528-5815 for Florida Healthy Kids. For Dental benefits and prior authorization, please contact the member's Dental vendor.
Services include: prior authorization and utilization review, care coordination, quality improvement activities, medical record review, health and wellness, and quality review services for home and community-based waiver programs. eQHealth Solutions is a market leader in assisting health care providers to adopt information technology services ...
Step 1: Access eligibility and benefits information on the Availity Web Portal . Step 2: Use the Prior Authorization tool above or within Availity. Step 3: If the service/procedure requires preauthorization, visit the Availity Web Portal . To request authorizations: From the Availity home page, select ‘Patient Registration’ from the top navigation.