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.
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 Physician Fee Schedule (under Current Fee Schedules)
Idaho Prior Authorization Codes
New Concurrent Review Submission Process
Provider Manual
Qualitrac User Guide
Qualitrac 3.0
Provider Communication
Provider Resources
Provider Education