Who is Qlarant?
Qlarant is a Quality Improvement Organization (QIO-like) working in partnership with the State of Florida’s Agency for Health Care Administration (AHCA) and the Agency for Persons with Disabilities (APD). Our number one goal in the state of Florida has always been and will continue to be improving the quality of supports for Florida citizens with developmental disabilities. The values we support and actively promote are rights, choice, full inclusion, health and safety, respect and dignity, and the person’s satisfaction with all services and supports.
What are the Medicaid Waiver services reviewed by Qlarant?
The services reviewed by Qlarant are Life Skills Development 1 (Companion), Life Skills Development 2 (Supported Employment), Life Skills Development 3 (Adult Day Training), Behavior Analysis, Behavior Assistant, Residential Habilitation (Standard, Behavior Focus, and Intensive Behavior), Personal Supports, Respite (Under 21), Waiver Support Coordination/CDC+ Consultant, Special Medical Home Care, and Supported Living Coaching. Qlarant also conducts reviews with Consumer Directed Care Consultants and Representatives.
As a provider, when will my review be held, and who will be my Quality Assurance Reviewer (QAR)?
You will receive a notification letter from Qlarant informing you your review will take place sometime within the next 90 days. You will receive a call up to 30 days in advance from the Quality Assurance Reviewer who will work with you to schedule your review.
I have a scheduled review, but I am no longer available. What should I do?
As soon as you are aware of a conflict, you should contact your reviewer to discuss next steps. Providers who are not present at the time of a scheduled review are scored non-compliant. Non-compliance results in a score of 0% for the review. Agency providers should assure availability of a backup person to participate in the review and present necessary documentation including personnel files, and individual and administrative records.
Where can I find the tools the Quality Assurance Reviewer will be using for my review?
I updated my provider name and phone number with APD. Why has Qlarant not updated it?
Qlarant receives provider information and claims data from AHCA on a monthly basis. Providers can update or change their contact information via the Florida Medicaid Fiscal Agent Provider Enrollment Unit at: 1-800-289-7799, 8AM – 5PM ET, Monday – Friday portal.flmmis.com/FLpublic/ (see Provider Support). When you receive a notification letter for an upcoming review, the phone number Qlarant has on record is included. If this is incorrect, please contact us at 866-254-2075 to update. Qlarant records are updated for the current year only. You would still need to complete updates with AHCA.
May I get an extension to file my reconsideration request?
No. The Reconsideration Request must be made in writing and received within 30 days of the mailing of the annual PDR report. If the request is not submitted within the 30 days, it will not be processed and the request will be deemed ineligible. You have the option of submitting the Reconsideration Request by hand delivery, mail or by secure fax to the Tampa or Tallahassee address/Right Fax number located below. Complete instructions on how to request for reconsideration can be found at the end of your report. Upon receipt, your Reconsideration Request will be entered into a tracking system to ensure Qlarant completes the Reconsideration Report within 30 days of receipt of your request. The fax number is toll-free at 1-888-877-5526.
I completed my APD plans of remediation/correct-should I send it to Qlarant?
No. You do not need to send this information to Qlarant. Remediation activities are facilitated by your Regional APD office. For a list of APD Regional offices, please visit www.apdcares.org.
Who can I talk to about paying my billing discrepancy? Could I get an extension on this?
Qlarant does not have a role in repayment. Please contact APDproviderbilling@ahca.myflorida.com to discuss your options for repayment.
Where can I go to get CPR/First Aid/HIV Training?
For a list of approved training entities or upcoming training events, please visit the APD website at http://apd.myflorida.com/providers/training/service-specific-training.htm.
I am a new provider. Why am I not appearing as a provider on the provider search at flddresources.qlarant.com?
Providers will appear on the Public Reporting Website once Qlarant receives claims data from AHCA for that provider. Provider performance information is available for providers who have received a PDR from Qlarant in the past 18 months. Performance scores reflect waiver rule compliance based upon the number of standards reviewed during the PDR.
I am from another state and moving to Florida. Where do I go for services?
Please visit APD for eligibility requirements at www.apdcares.org.
What is the time frame for the review?
The review will be for the 12 months prior to the month of your review. Therefore, if you are being reviewed in October 2017, the reviewer will be reviewing all services rendered during the prior October 2016 –September 2017.
I was reviewed in October last year. Will my review always be in October?
Review schedules vary from year to year and are not always held in the same month as the prior year. The schedule for reviews is developed based upon the number and location of eligible providers in a given year.
I no longer render a certain service, why is the Quality Assurance Reviewer asking for it?
The review covers the prior 12 months. Therefore, if you are being reviewed in October, the Quality Assurance Reviewer will be reviewing all services rendered from October of the previous year through-September of the current year. Even if you are no longer rendering the service, it is still eligible for review because it was rendered and billed for within the 12-month review period.
I render services in multiple Areas of one Region. Will I have only one Review?
Effective 1/2015, if you are a Waiver Support Coordinator you will have one PDR per APD Region. Effective, 7/2018, if you are a provider of the other Medicaid Waiver services, you will have one PDR per APD Region unless APD requests the reviews to be conducted by Area.
I need another copy of my report. Could you email it to me?
No, Qlarant cannot send the reports through electronic mail. Reports contain protected health information (PHI) therefore, they are mailed to providers.