Online Help Help

  • Idaho Medicaid Program
    Health Coverage
    for Idaho families
  • Idaho Medicaid Program
    Health Coverage
    for Idaho families
  • Idaho Medicaid Program
    Health Coverage
    for Idaho families
    
Healthy Connections Rosters

​The April Healthy Connections Rosters have been posted to your secure Trading Partner Account. 

Pharmacist Services – Reminder on Billing Medical Claims
Pharmacists are eligible to enroll as a non-billing Ordering, Referring or Prescribing (ORP) providers, and once enrolled they may extend some services, as outlined in the Idaho Pharmacy Act, to participants in the pharmacy or in the clinic. Pharmacist providers cannot be billed as the rendering provider, only as the ordering, referring, or prescribing provider.
 
A pharmacist cannot bill directly for services. If a clinic is billing for services, a rendering provider may still be required on the claim. This information applies to non-pharmacy claims. Medical claims are submitted to Gainwell for processing. Prescription drugs such as oral tablets, capsules, liquids, etc. that are self-administered by the patient are submitted in the usual way through the Magellan POS System.
 
At this time, IDHW and Gainwell are discussing how to change and enhance the system to allow for pharmacist providers to be billed as a rendering provider. We will communicate more to our provider community within the coming weeks. Thank you for the continued partnership to provide the best care for our Idaho Medicaid recipients. 
Portal Enhancement and Redesign
In the coming weeks Gainwell will release a few enhancements and redesign to the public and general pages on this provider portal. We highly encourage you to check out the article in the April Newsletter titled Upcoming Provider Portal Enhancements, which will give you an overview and sneak-peek preview of the changes.

We hope these changes offer a simple and resourceful experience on the portal for our provider community.
Provider Workshops in Lewiston and Twin Falls – Register Today!
Gainwell is hosting an in-person provider workshop to give an opportunity for our providers and their staff personnel to join us in Regions 2 and 5 at the locations noted below. We will be presenting a comprehensive review of the features in your Trading Partner Account and assisting our providers in understanding how their office can leverage technology to enhance the security for their provider record. Topics include TPA registration, managing users, and security regarding your account information. We look forward to connecting with providers at these events! Register here by signing in and searching in the catalog for the Provider Workshop, and if needed reference these registration instructions. Please contact IDTraining@gainwelltechnologies.com for any support to register for the event.
  • May 24, 2024: Region 2 – Lewiston from 10:30-12:30 MST at the IDHW Building located at 1118 F Street, 3rd Floor Conference Room, Lewiston, ID
  • June 5, 2024: Region 5 – Twin Falls from 10:00-12:00 MST at the IDHW Building located at 601 Pole Line Road, Conference Room A, Twin Falls, ID
Idaho Health Care Conference 2024 – Register Today!
Gainwell is eager to invite providers and their staff personnel to the in-person, statewide Idaho Health Care Conference (IHCC) in May and June, from 8:00 to 4:00 PM MST at the locations noted below. We will be presenting a comprehensive review of the features in your Trading Partner Account and assisting our providers in understanding how their office can leverage technology to enhance the security for their provider record. Topics include TPA registration, managing users, and security regarding your account information. We hope you’ll attend the conference at a location near you! Learn more and register here. 

  • May 23, 2024: North Idaho—Red Lion Templin's Hotel on the River, Post Falls
  • June 04, 2024: Eastern Idaho— Shoshone-Bannock Hotel & Casino, Fort Hall
  • June 06, 2024: Treasure Valley— Galaxy Event Center (Wahooz), Meridian 

Dial 1 When You Call!
It is very important that you dial a 1 when calling us. Please call 1(866) 686-4272. Thank you! 

 Welcome

Welcome to the Idaho Gainwell Technologies Online Portal for Medicaid Providers!
This website provides information to Idaho Medicaid providers, trading partners, and the public. Helpful documents and links can be found in the menu bar above. Click here to sign in to your secure Trading Partner Account. Once logged into the secure portal, you can perform enrollment and maintenance, view eligibility and authorizations, view and submit claims, download reports, and more.

 Scheduled System Downtime

Click ​The Idaho Medicaid website is down each week from 4 PM on Saturday to 10 AM on Sunday for regular maintenance.  During this time, eligibility inquiries are available through our telephone system at 1 (866) 686-4272.  Any changes to this standard maintenance window will be communicated via an announcement on this website.  ;

 ‭(Hidden)‬ COVID-19

Official Resource for Novel Coronavirus(COVID-19) :
https://coronavirus.idaho.gov/resources-for-healthcare-providers
Information Releases :
/Lists/Information%20Releases/AllItems.aspx

 Claims Processing


Paper claims must be received by 5:00 P.M. Monday in order to be included in the next regular weekly payment processing cycle.

Electronic claims must be received by 8:00 p.m. Thursday to be included in the next regular weekly payment processing cycle.

Click here to view the 2023 Financial Payment Processing Cycles.

There are no items to show in this view of the "Medicaid Program Integrity" list.

 Trading Partner Account Login

Click here to sign in to your secure Trading Partner Account.  By logging into the secure portal, you can view eligibility, view and submit claims, manage patient rosters, perform enrollment and maintenance, view authorizations, download reports, and more. 

 Gainwell Technologies Partners

Click here for a list of contact information for our valued partners. 
Attention! Behavioral Health Providers

​If you are a provider who is enrolling or enrolled as a Mental Health Clinic, Rehabilitative Mental Health Service provider, Mental Health Case Management provider or any other provider that renders behavioral health services, you may also be required to enroll and maintain your provider record with Optum Idaho. For more information, contact Optum. Regional Network Managers can assist you and are listed on the Regional Representation Flyer found at www.OptumIdaho.com > Contact Us tab. 

 ‭(Hidden)‬ Prospective Providers and Enrollment

Welcome to the Idaho Gainwell Technologies Prospective Providers and Enrollment documentation!


This is a testing text for this Prospective Providers and Enrollment documentation Web Part 


Click here to access Prospective Providers and Enrollment documentation.

 Idaho Medicaid Member Resources

​Participant Services Phone ​1 (866) 686-4752 (Toll-free), 1 (208) 373-1432 (Local)
​Participant Services E-mail idparticipantservices@gainwelltechnologies.com
​Participant Information Website https://healthandwelfare.idaho.gov/services-programs/medicaid-health
​Language Services http://healthandwelfare.idaho.gov/AboutUs/LanguageAssistance/tabid/3766/Default.aspx
​Idaho Health Plan Coverage Booklet - English https://publicdocuments.dhw.idaho.gov/WebLink/DocView.aspx?id=2080&dbid=0&repo=PUBLIC-DOCUMENTS
​Idaho Health Plan Coverage Booklet - Spanish https://publicdocuments.dhw.idaho.gov/WebLink/DocView.aspx?id=2081&dbid=0&repo=PUBLIC-DOCUMENTS

 Gainwell Technologies Contacts

Gainwell Provider Relations Consultants Contact Information
Idaho Medicaid Contact Information (Provider Services, Provider Enrollment, and Gainwell partners)

 

 Resources & Links

 

Provider Training
Opportunities

Click here to view the Training Calendar and browse upcoming training opportunities.  Please log into the Idaho Medicaid Training Center to register for training sessions. 

For training support, contact IDTraining@gainwelltechnologies.com.