Idaho Medicaid Health PAS OnLine > Announcements
After our Trading Partner Account (TPA) upgrade this fall, all enrollment and maintenance, including paper forms, will be moved behind the secure TPA account. These will not be available in the Billing Agent’s TPA. If you submit maintenance or enrollment for the providers you represent, please work with your provider to set up their TPA account, if they have not yet registered for one. The provider should maintain the role of TPA Account Administrator. Once the TPA is registered, the provider can add and manage users who access their TPA and control the security level of each. Instructions can be found in the Trading Partner Account (TPA) User Guide. In addition, you may reach out to your regional Provider Relations Consultant (PRC) for assistance with setting up the TPA.
This Fall, the Trading Partner Account (TPA) portal is being upgraded to a new version. All providers—including those who utilize billing agencies—will be required to have a TPA account in order to perform enrollment and maintenance. Billing agencies will not have access to the enrollment and maintenance portal for the providers they serve. Please see the July MedicAide newsletter for more information.
The July edition of the MedicAide Newsletter is now available online. Please click here for the latest news and information affecting Idaho Medicaid providers. If you must receive the MedicAide by mail, please dial 1 (866) 686-4272 and select option 3.
Effective date of service July 1, 2017, and forward, CPT 43647 - Laparoscopy, surgical; implantation or replacement of gastric neurostimulator electrodes, will be non-covered by Idaho Medicaid. This medical procedure is deemed investigational in nature according to the benchmarks used by Idaho Medicaid to determine coverage.
Effective for date of service July 1, 2017, and forward, HCPCS code L8680 - Implantable neurostimulator electrode, is non-covered by Idaho Medicaid. Medicare has incorporated L8680 into CPT 63650 - Percutaneous implantation of neurostimulator electrode array, epidural, and adjusted the pricing. Providers should not bill L8680 in conjunction with a lead implantation procedure; L8680 has been removed from the Medicaid covered services schedule. For more information concerning L8680, see MLN Matters MM8645 April 1, 2014.
If a participant has primary insurance and their primary insurance claim has denied or paid at zero, providers must enter the Coordination of Benefits information in the COB Information section of the claim in addition to uploading the primary insurer's Explanation of Benefits (EOB). The EOB must include the EOB summary page. If the primary paid amount is zero, providers must enter zero and enter the paid date as the date of the EOB. If reporting both a co-pay amount and a coinsurance amount, these need to be added together and entered under coinsurance. These steps must be followed in order for us to process your claim correctly.
It is very important that you dial a 1 when calling us. Please call 1 (866) 686-4272.