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Upcoming Provider MeetingsNew

​Idaho Medicaid is hosting DMEPOS Provider Meetings on Tuesday, June 18, 2024 and Therapy Provider Meeting on Tuesday, June 25, 2024 at 10:30 A.M. For more information or to request the meeting invite send an email to: 

Memorial Day Holiday and Financial Cycle

​Due to the Memorial Day Holiday, Claim Payments, Remittance Advice (RA), and/or HIPAA 835 Claim Advice Files for the financial week of 5/23/2024 will be delayed by 1 day. 

Provider Handbook Updates

​Updates have been made to the Provider Handbook. You may find the link under the Reference Material menu on this website. Changes are noted in each document. The updated document is:

  • Therapy Services
New Idaho Behavioral Health Plan (IBHP) - Effective July 1, 2024

The new IBHP plan, managed by Magellan Healthcare, Inc., will oversee behavioral health services for Idahoans who have Medicaid, who have other types of insurance, and who don't have insurance.

Eligible participants under the IBHP who receive inpatient, ER, and residential services directly related to a primary diagnosis of behavioral health will be eligible for covered by Magellan beginning July 1, 2024. Gainwell will continue to pay fee-for-service for inpatient, ER, and residential services related to a primary diagnosis of physical health.

For eligible participants, Magellan will honor all authorizations from Telligen, Gainwell, BPA Health that have been approved and span past July 1, 2024. Magellan will also waive outpatient authorizations from Optum for the first 90 days after July 1, 2024, for eligible participants. An eligible participant in active treatment with an out-of-network provider may continue receiving services from that provider for the first 90 days after July 1, 2024, and Magellan will cover the services.

Visit Magellan's website for more details about the transition and to access Magellan trainings.

Payment Error Rate Measurement (PERM) Audit Beginning

​PERM is an audit that is conducted by the Centers for Medicare and Medicaid Services (CMS) to determine the accuracy of state Medicaid payments. The current PERM cycle is reviewing payments made by Idaho Medicaid from July 1, 2023 through June 30, 2024. Requests from PERM auditors for provider medical records associated with the sampled claims will begin in May/June 2024. Federal regulations require providers to submit information regarding payments and claims as requested. Additional information about PERM will be published in the June MedicAide newsletter.
For more information about PERM, please see our Frequently Asked Questions at: 

Provider Portal Enhancements

Gainwell, in collaboration with IDHW, released a few enhancements to the provider portal. We did this with intent to create a functional and simple experience for our portal users. A recap of the changes:

  1. We moved the Claims Processing Cycle and Medicaid Program Integrity information from the General home page to the Provider page.
  2. We changed the view on the Announcements page and moved them to the center of the home page, to allow more room and visibility into the current announcements. The full announcement text can be viewed with a single click and should offer better viewing for the reader.
  3. We have created a new section on the home page for our prospective providers and the enrollment process. The toolkit is full of information related to the enrollment process, Trading Partner Account and Training registration, new enrollment checklists that guide different provider types through the process of enrollment, along with full enrollment and Trading Partner User guides that describe navigational aspects of the system at great length.
  4. Reminders or Tips from Gainwell is a place that providers could reference for system, claim, or eligibility reminders that will be frequently refreshed.
  5. The Reference Material window was updated to realign the Medicaid Fee Scheduled under the Links header, the FAQs language was updated to include our Best Practices reference along with the new Prospective Providers and Enrollment page.

If you need any help or support with navigating the portal, representatives would be glad to assist you from 7:00 AM to 7:00 PM MST by calling 1(866)686-4272 option 2 for EDI and technical support. 

New Provider Enrollment Checklists

An area of focus that Gainwell has committed to is establishing quick reference materials for the provider community. New Enrollment Checklists were created for all 27 enrollable provider types, which outline the specialties that are eligible to enroll, a list of what is needed or required during enrollment, special instructions and nuances that can be expected, and direction for our prospective provider community.

In instances where there are special instructions, you will notice the provider specialty text in a specific color. All other text within the document is intended to be used by all specialties. Additionally, in the coming weeks several new e-Learning videos will be released into the Idaho Medicaid Training Center that offer another perspective to understanding the enrollment process. We hope these tools are helpful for our provider partners and look forward to your feedback.

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. 
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 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!