Quality Review/Retrospective Audit

eQHealth Solutions is the Medicaid Quality Improvement Organization (QIO) that is responsible for conducting retrospective reviews of services provided to Medicaid beneficiaries. The Arkansas Department of Human Services, Division of Medical Services, has contracted with eQHealth Solutions to complete retrospective review of services delivered to Medicaid beneficiaries by doing the following:

 

(1)  Determine if those services are delivered in accordance with the plan of care and conform to generally accepted professional standards.

 

(2)  Evaluate the medical necessity of services provided to Medicaid beneficiaries.

 

(3)  Evaluate the clinical documentation to determine if it is sufficient to support the services billed during the requested period of authorized services.

 

(4)  Safeguard the Arkansas Medicaid program against unnecessary or inappropriate use of services and excess payments in compliance with 42 CFR 456.3(a).

Accessing Your Review

Accessing Your Audit in the eQSuite Portal

What do you do when you get your Retrospective Audit notification letter and you don’t have access to the eQSuite portal?

 

The below information is included on every letter:

Date of the notice

Beneficiary name, ID, and DOB

Provider Name and NPI

Treatment service

Case number within eQHealth Solutions Portal

Claim number

Dates of services requested

 

In order to process this request electronically, you will need to register for the portal (click on the link). Below is the information that you will need to register.

Desired username

Desired password

First and Last name

Email address

Unit or Department name

Provider name

Phone number

NPI (Found on the Letter)

Provider Medicaid ID (ID the claim was paid under, found on the claim)

Address

 

 

Click Submit at the bottom of the form and receive 1 of 2 outcomes

You will receive an email with further instructions

OR

You will receive an error message that says “Contact your System Administrator”

 

Who is your “System Administrator?”

Your system administrator is the person at your facility who created the first access in our portal, using that  Medicaid Provider ID. They will create your access for you.

 

What do you do after obtaining access to our portal?

Log in and follow the steps on the Retrospective Audit User Guide (click on the link).