This revised Provider Manual was prepared for the Alaska Division of Health Care Services by Qualis Health in October 2007.

2007 Provider Manual

The purpose of this manual is to provide information to providers regarding the Medicaid Review Programs for Alaska Division of Health Care Services clients. The following is a list of the chapters:

Section I. Care Management Program Overview
Section II. Communication with Qualis Health
Section III. URAC Compliance
Section IV. HIPAA
Section V. Provider Billing Concerns
Section VI. Eligibility Categories
Section VII. Utilization Review Process
Section VIII. Web-based Utilization Review
Section IX. Pre-service Utilization Review
Section X. Concurrent Review
Section XI. Physical Rehabilitation Review
Section XII. Retrospective Review
Section XIII. Quality of Care
Section XIV. Special Case Review
Section XV. Utilization Review
Section XVI. Case Management
Appendix A. Select Pre-auth List
Appendix B. Glossary of Terms
Appendix C. Key Contact Personnel
Appendix D. List of Exhibits