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July 24, 2016

Surgery and Procedures

To determine whether or not a surgery or procedure requires a Prior Authorization, please see the current Medicaid Fee Schedule

Providers submit a request to either Qualis Health or Medicaid’s Medical Care Unit, but not both.   

Please see the ICD-9 list of procedures and diagnoses requiring prior authorization from Qualis Health or the ICD-10 list of procedures and diagnoses requiring prior authorization from Qualis Health to determine if you should request a prior authorization from them.

Those requiring a prior authorization, and are not reviewed by Qualis Health, are reviewed by the Medical Care Unit as established in the list of surgeries requiring prior authorization from Medicaid's Medical care Unit.

The Medical Care Unit also reviews a select number of inpatient hospital procedure codes.

Please review the Surgery FAQs for more information.

Medical Care Unit Authorizations

Prior authorizations that are not reviewed by Qualis Health should be faxed to the Medical Care Unit at (877) 314-8779 on the Medical Prior Authorization Form. Please, include proof of medical necessity with your request. Requests are only accepted by fax.

The status of a prior authorization request may be checked online at the Molina Health PAS portal under “Authorization Status”, using your NPI, or by contacting Molina at (866) 686-4272.

For other questions or general information, contact (208) 364-1833.

Qualis Health Authorizations

Prior authorizations through Qualis Health may be submitted through the provider portal.

Requests may also be faxed to (800) 826-3836 or mailed to:

Qualis Health
ATTN: Prior Authorizations
PO Box 33400
Seattle, WA 98133-0400

The status of a prior authorization request may be checked online at the provider portal, or by contacting Qualis Health at (800) 783-9207.

Please, contact Qualis Health at (800) 783-9207 if you require additional information or assistance.

Contact

Medical Care Unit 

Phone: 1 (208) 364-1833
Fax: 1 (877) 314-8779

 Qualis Health
ATTN: Prior Authorizations
PO Box 33400
Seattle, WA 98133-0400

 Phone: 1 (800) 783-9207
Fax: 1 (800) 826-3836