Reconsideration Process

Request for Reconsideration Review

eQHealth Solutions offers providers an opportunity to request a reconsideration review when an adverse determination is received. A request for reconsideration is applicable for a) full or partial medical necessity denial determinations, b) Lack of Information (LOI) denials, and c) other technical denials.

A requesting provider, attending or ordering physician may request a PAR reconsideration for a denial due to lack of medical necessity. A request for reconsideration may be submitted electronically via eQSuite®, or by fax or mail within 10 Business days for outpatient settings or 5 business days for IHRP from the date of the adverse determination. 

If you are submitting your Reconsideration Request by fax, phone, or mail, click the link below to download or print the reconsideration form and instructions: 

Reconsideration Form

Please refer to the Reconsideration Guides for detailed instructions


    
Reconsideration User Guides