Document Library

Security Admin Registration Form - The Telligen Qualitrac Provider Portal is a web application which allows healthcare providers to request and view the status of medical reviews. Each provider organization will delegate administrative rights to one or more individuals within their organization to serve as Security Administrator. The Security Administrator will be the point of contact for the organization and have the ability to add, remove or edit Provider Users accounts. Each Security Administrator must complete the Provider Portal - Security Admin Registration Form.

Case Management Forms

Forms
   
C-Section Concurrent Review Fax
    Complaint
    Concurrent Review Fax
    Inpatient Psych Concurrent Fax
    Inpatient Psych (Over 21) Prior Authorization Fax
    Inpatient Psych (Under 21) Prior Authorization Fax
    Prior Authorization Fax
    Rehabilitation Prior Authorization Fax

Idaho Plan Benefits
    Medicaid Basic Benefit Plan
    Medicaid Enhanced Benefit Plan

Manuals and User Guides  
   
Auto Authorization FAQs
    Idaho Prior Authorization Codes
    New Concurrent Review Submission Process
    Provider Manual
    Qualitrac User Guide