Provider Resources

March 19, 2020: COVID-19 and Business Continuity

During the current COVID-19 emergency, Comagine Health is fully staffed and business operations are not interrupted.

For utilization review, case management and related activities, we are continuing to process requests and answer calls via our toll-free numbers during standard business hours. We have business continuity plans in place to serve our clients, health care providers, patients and communities while also protecting our staff and minimizing the spread of the illness.

Division of Public Assistance Forms

• Denali KidCare Income Guidelines
• Med 4 - Application for Adults and Children with Long Term Care Needs
• Med 1 - Child's Medical History and Disability Report
• Med 2 - Release of Information (six signed originals needed)
• Med 15 - Alaska Medicaid - TEFRA Brochure
• Social Security Disability Listings

Division of Senior and Disabilities Services Forms

• Qualifying Diagnosis Certification
• IDD-03 ICAP Assessment Information and Consent Form
• Authorization for Release of Information
• SDS Regulations
• SDS E-News

Care Coordinator Manual and Forms

Submitted to Qualis Health by Care Coordinator

• Care Coordinator Manual - current
• Alaska Medicaid - TEFRA Checklist
• Nursing Facility Level of Care (LOC) Form
• Inpatient Psychiatric Hospital (LOC) Form
• Plan of Care (POC) Form
• Estimated Medical Expenses (COC) Form
• 24-hour Log
• Med 36 - TEFRA Initial Application Extension Request Form

Presentations

• Division of Public Assistance Care Coordinator Training

Additional Information

• Alaska Medicaid - TEFRA Frequently Asked Questions
• Alaska Medicaid - TEFRA Definitions
• Alaska Medicaid - TEFRA Application Process Chart
• Case Examples
• HIPP Application

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