Skip to main content
  • Medicaid Provider Alert: Provider revalidation has begun and those not completing the process risk disenrollment.  Check your account now to learn when your revalidation is due. More information here.
Elizabeth M. Whitehorn, Director

Provider Notice Issued 02/09/2017

 

New Web-Based Medical Record Submission Process for Retrospective Pre-Payment and Post-Payment Utilization Review Effective with Dates of Notice Beginning April 11, 2017

 

Date:   February 9, 2017

 

To:       All Enrolled Hospitals:  Chief Executive Officers, Chief Financial Officers, Patient Accounts Managers, and Health Information Management Directors

 

Re:      New Web-Based Medical Record Submission Process for Retrospective Pre-Payment and Post-Payment Utilization Review Effective with Dates of Notice Beginning

            April 11, 2017

 

 

 

The Department, in conjunction with its Quality Improvement Organization, eQHealth Solutions, Inc. (eQHealth), announces a new web-based medical record submission process for retrospective pre-payment and post-payment reviews. This new process will be effective with eQHealth’s Notice of Selection of Medical Records for Offsite Review beginning with Date of Notice April 11, 2017.

The transition to a web-based submission process will benefit providers by eliminating the expense of photocopying and mailing hard-copy medical records, as well as reducing the risk of HIPAA non-compliance.

 

eQHealth has added a new menu option to eQSuite® that will display a list of all admissions where medical records for retrospective pre-payment and post-payment review have been requested. Providers will receive an email alert when new cases are selected for their facility. This email will instruct providers to check for new retrospective cases in eQSuite® under the Retro Chart Requests tab.

 

For each admission, the provider will have the option to directly link one or more electronic files, or create a fax coversheet if portions of a chart cannot be easily uploaded. After all necessary documentation has been linked and/or faxed, the provider will indicate that the case is ready for submission to eQHealth. Once this process is completed the documents are directly linked to the correct case and it becomes available for Level 1 nurse review.

 

Exceptions to Submitting Retro Charts through eQSuite®

Using the following criteria, eQHealth will employ a stringent exception process to allow submission of condensed medical records by mail for:

·       Out-of-state hospitals in non-contiguous counties.

·       Low-volume hospitals with five or less retrospective reviews per month.

·       Emergency situations including disasters or extended power outages (does not pertain to temporary Internet unavailability).

 

 

eQHealth will conduct provider education and outreach prior to implementation, including webinar training for medical records staff, and post frequently asked questions. Hospital administrators should direct their Medicaid liaisons to anticipate a Provider Update from eQHealth with further details and information for upcoming educational sessions and training.

 

Any questions regarding this new submission process may be directed to eQHealth by submitting an online Helpline ticket through eQSuite®. Any questions regarding this notice may be directed to the Department at 217-785-0710.

 

 

 

Felicia F. Norwood

Director