Provider Resources

Go to: Qualis Health Provider Portal | CPT Codes for Review | Request Forms | Questionnaires | Criteria & Guides

Qualis Health Provider Portal

The Qualis Health Provider Portal is a web-based application that allows you to submit utilization management (UM) review requests via the internet. Washington state providers access the Qualis Health Provider Portal through OneHealthPort.

Go OneHealthPort / Qualis Health Provider Portal

Beginning January 1, 2017, providers located in Washington state must use the Qualis Health Provider Portal to submit requests for imaging and spinal injections.

View the announcement flyer for more information

In order to submit requests via the Qualis Health Provider Portal, your organization must be registered with both OneHealthPort and the Qualis Health Provider Portal.

• Instructions for registering with OneHealthPort and the Qualis Health Provider Portal
• Instructions for accessing the Qualis Health Provider Portal via OneHealthPort

CPT Codes for Review

• Spinal Injection Procedure List
• Advanced Imaging Procedure List
• Surgical Procedure List

Request Forms

• When to Submit to Qualis Health
• Spinal Injection Request for Review Form
• Advanced Imaging Request for Review Form
• Surgical Procedure Request for Review Form

Questionnaires

Spinal Injection

• When to Submit to Qualis Health
• Diagnostic Facet Injection and Medial Branch Block Questionnaire
• Sacroiliac Joint Injection Questionnaire
• Therapeutic Epidural Steroid Injection Questionnaire

Advanced Imaging

• When to Submit to Qualis Health
• Brain Imaging Questionnaire
• Brain PET Scan Questionnaire
• Breast MRI Questionnaire
• Cardiac Imaging Questionnaire
• Cervical Spine MRI Questionnaire
• CT Abdomen and Pelvis Questionnaire
• CT Abdomen Questionnaire
• CT Pelvis Questionnaire
• Lower Extremity MRI Questionnaire
• Lumbar Spine MRI Questionnaire
• PET/CT Scan and PET Scan Questionnaire
• Upper Extremity MRI Questionnaire

If your PET scan request is part of IMRT or SBRT, do not submit it to Qualis Health. Instead, submit it with the authorization request for the radiation oncology procedures directly to Washington Medicaid.

Criteria & Guides

General

• Helpful Links
• When to Submit to Qualis Health

Spinal Injection

• Medical Treatment Guidelines (Washington L&I website)
• Spinal Injection Guidelines (Washington L&I website)

Advanced Imaging

• Advanced Imaging Prior Authorization through Qualis Health FAQs
• Cervical Spine Evidence-based Imaging Guidelines
• Headache Evidence-based Imaging Guidelines
• Lower Extremity Evidence-based Imaging Guidelines
• Lumbar Spine Evidence-based Imaging Guidelines
• Thoracic Spine Evidence-based Imaging Guidelines
• Upper Extremity Evidence-based Imaging Guidelines

Surgical Procedures

• Medical Treatment Guidelines (Washington L&I website)

Go to: Qualis Health Provider Portal | CPT Codes for Review | Request Forms | Questionnaires | Criteria & Guides | Top of Page

Adobe Acrobat® PDF files can be opened using Adobe Acrobat Reader. If you do not have Reader, you can get it free from the Adobe website.