Online Help Help

  
Body
  
  
  
Extended Maintenance Window February 27th New

​The Gainwell Technologies Idaho Medicaid Provider Portal will be down from 7:00 to 9:00 PM on Tuesday, 2/27/2024 for an extended maintenance window. During this time, eligibility lookups will be available through our Medicaid Automated Customer Service (MACS) line at 1 (866) 686-4272. Thank you for your patience during our maintenance period. 

2/27/2024 2:59 PM2/27/2024 2:59 PM2/27/2024
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 documents are:

  • Chiropractor
  • Hospital

2/26/2024 3:57 PM2/26/2024 3:57 PM3/4/2024
Resolved - Phone System Intermittently Unavailable

​The technical issue that was impacting our phone system and preventing Gainwell Technologies from receiving inbound telephone calls has been resolved. Thank you for your patience while we worked to resolve this matter.  

2/22/2024 1:30 PM2/22/2024 1:30 PM2/22/2024
Attention All Pharmacy Providers – Change Healthcare Service Outage

Gainwell and IDHW have been made aware this morning, that beginning February 21st Change Healthcare, a Point of Service (POS) vendor for some enrolled Medicaid Providers, has been impacted by a service outage. A recent communication from Change Healthcare follows:

Change Healthcare continues to address a network interruption related to a cyber security issue. In the interest of protecting our patients and partners, we have not yet reconnected our systems. The disruption is expected to last at least through the day. We will provide updates as available.

Participant eligibility can be verified by contacting the Medicaid Automated Customer Service (MACS) line, which is available Monday-Friday from 7:00 AM to 7:00 PM MST by calling 1(866)686-4272. Please be prepared with identifiers such as your NPI, participant MID and name available.

Thank you for your understanding. We will provide updates as they become available.

2/22/2024 9:44 AM2/27/2024 3:02 PM3/1/2024
Phone System Intermittently Unavailable

​Due to technical issues, Gainwell Technologies is intermittently unable to receive inbound telephone calls. We are working towards a remedy and will provide periodic updates in the announcements on www.idmedicaid.com. In the mean-time, providers can utilize self-service options through their secure Trading Partner Account, or contact us by email. Please see the Contact Us tab on the website for a list of addresses. We apologize for any inconvenience and thank you for your patience

2/22/2024 9:04 AM2/22/2024 9:04 AM2/22/2024
Presidents’ Day Holiday and the Financial Cycle
​​Due to the Presidents’ Day Holiday, Claim Payments, Remittance Advice (RA), and HIPAA 835 Claim Advice Files for the financial week of 2/15/2024 will be delayed by one (1) day.
2/15/2024 4:17 PM2/15/2024 4:17 PM2/23/2024
Healthy Connections Rosters

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

2/12/2024 9:44 AM2/12/2024 9:44 AM2/19/2024
Best Practices for a Claim Review Request
A Claim Review Request is available to providers who are seeking an additional review on their claim.  

The Claim Review Request instructions and form can be found by hovering over the Reference Material tab and selecting Gainwell Technologies Forms or by following this link. Any request that is received on any form other than the one located on our website, or when the form is not completed in accordance with the instruction, may be rejected and returned. As a reminder, use blue or black ink on the form, in order for your request to be indexed correctly into our system.

A Claim Review Request can be used for many reasons, but should not be used in some instances. Here are a few examples:
CRR is used: CRR is not used:
If you disagree with the denial or payment of a claim and would like it manually reviewedTo adjust a claim and attach documentation (for example: EOB, invoice, sterilization/hysterectomy consent forms, NOA for timely filing, run/trip report)
If the claim has denied for a bundling issue against another denied claim/service lineFor Share of Cost (SOC) issues
If the claim has denied for duplicate claim issues inappropriatelyTo request additional information on a Health Management Systems (HMS) adjustment/recoupment
If a service was denied for a lifetime benefit exceeded inappropriatelyTo request a recoupment when the claim is within the 2-year adjustment period
To adjust a claim after a participant's eligibility has been updated

It's best practice and encouraged for providers to use the provider portal to reverse and adjust claims when necessary to attach documentation or reprocess the claim, especially in the instances noted above when a CRR is not used. Please reference the section titled Reverse or Adjust a Claim in the Trading Partner Account (TPA) User Guide for more information on how to navigate the provider portal.

All Claim Review Request forms must be mailed to Gainwell Technologies. Any CRR forms that are received via fax or email will not be processed into the system.

In the case where you may have more than five Claim Review Requests to send to Gainwell for reconsideration, you're encouraged to engage with your Provider Relations Consultant first; they can assist you with the denial and ensure using the CRR process is the most efficient way for your claim issues to be addressed.

When attaching documentation to the request do not attach the patient's entire medical record. For safety and efficiency in processing we ask that you only attach documents that are pertinent to the claim under review.

2/2/2024 5:46 PM2/2/2024 5:46 PM2/29/2024
Provider Portal Errors – Actively Investigating

​The provider portal is currently experiencing longer than usual response times, user name and password errors are displaying for some, and others have reported a 503 error code.  Gainwell Technologies is aware and actively working to resolve this matter. Please attempt to log back into your Trading Partner Account in approximately 30 minutes. A password reset is not necessary, unless desired. Additional information, when available, will be posted here in the Announcements. 

2/1/2024 12:23 PM2/1/2024 12:23 PM2/1/2024
February MedicAide Newsletter Now Online

​The February edition of the MedicAide Newsletter is now available online. Please click here for the latest news and information affecting Idaho Medicaid providers

2/1/2024 10:40 AM2/1/2024 10:40 AM2/15/2024
1 - 10Next