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 provider, attending or ordering physician may request a PAR reconsideration of an adverse determination rendered by an eQHealth Physician Reviewer. A request for reconsideration may be submitted electronically via eQSuite®, or by fax or mail within 10 business days from the date of the adverse determination. 

Please refer to the Reconsideration Guide for detailed instructions:

Reconsideration Review Process - Provider Guide


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

Reconsideration Form