Hospital Contact Information

Healthcare and Family Service Medicaid program requires vital communication with hospital personnel. It is important to have current contact information for the following members on the Hospital Contact Form:

Hospital CEO or CFO

The hospital CEO or CFO information is used as appropriate approval for assigning the eQHealth Liaison at each facility. The contact information may also be used in targeted communications.

Hospital CMO or Medical Director

The hospital CMO or MD's contact information is used only for targeted communications.

eQHealth Liaison

The eQHealth (Medicaid) Liaison is selected by a member of  hospital administration. His/her role is to be the primary contact between eQHealth Solutions and the hospital. All provider communications, notifications, and letters are sent to the liaison.

eQHealth Quality Contact

The eQHealth Quality contact is selected by a member of hospital administration. His/her role is to be the primary contact between eQhealth Solutions and the hospital regarding quality of care.

Web Administrator

To access eQHealth's Web-based system and provider-specific reports, each hospital may register for a free Web account and must designate a Web Administrator. The Web Administrator is responsible for assigning access rights and maintaining login ID's for eQHealth Web users at their facility.


 Need to add/update your hospital contacts?

  Click HERE to download the Hospital Contact Form.

Prior Authorization Template and Instructions

The Prior Authorization Template can be used by hospitals as a tool to gather all the pertinent clinical information from the attending (surgeon) physician prior to submitting a request via eQSuite™. The Prior Authorization Template is optional, hospitals are not required to submit the form to eQHealth.

Click on the links below to download the template and instructions: