We want to ensure you have the most up‑to‑date information regarding the therapy‑related changes outlined in Information Release MA26‑05. Our teams are actively collaborating to align system updates as efficiently and effectively as possible. An open ticket and ongoing dialogue are in place to complete this alignment.

Prior Authorization (PA) Submissions

Therapy‑related prior authorizations should be submitted using the Therapy Prior Authorization Form:

• Document Exchange (Provider Portal Upload): Upload the completed form via the portal's Document Exchange.
• Fax: Submit the completed form via 1-877-314-8779

Form Location: https://www.idmedicaid.com/Lists/Form%20Links/Links.aspx
Provider Services: 1‑866‑686‑4272
For system support with Document Exchange, please refer to the TPA User Guide (Section 4.3. Document Exchange) on the portal or call the Provider Services Line above.

How to Check Authorization Status

Per the TPA User Guide (Section 3.1 – View Authorization Status):
https://www.idmedicaid.com/User%20Guides/Trading%20Partner%20Account%20(TPA)%20User%20Guide.pdf

Providers can view the status of their participant's authorization online within their Trading Partner Account (TPA) by navigating to "View Authorizations" once signed in. For detailed instructions, please refer to the section above.

If providers do not see an approved or denied authorization online within 5 business days after submitting the request, they may contact the Medical Care Unit at 1‑866‑205‑7403 to follow up on the status of the request.

Limitation Information: Temporary Accuracy Notice

Limitation information may currently display in the provider portal; however, values may be inaccurate because the display is still based on prior annual cap calculations, while therapy limits are now effective 1/1/2026 determined by a visit‑count cap. The portal display will be updated to reflect the new calculation methodology.

What this means for you:

• Please use PA approvals and official guidance as the source of truth for limits until the portal update is complete.
• We will notify providers as soon as limitation information in the portal reflects the visit‑count methodology.

Additional Resources

The Idaho Department of Health and Welfare (IDHW) maintains a resource page for Medicaid providers, including an upcoming list of Provider Frequently Asked Questions (FAQs) related to these and other program updates.
You may access this page here:
https://healthandwelfare.idaho.gov/providers/idaho-medicaid-providers/information-medicaid-providers

Next Steps

We will issue a follow‑up communication once system updates are complete and validated, confirming when portal limitation information accurately reflects visit‑count caps.

If you have questions or need support, please contact Provider Services at 1‑866‑686‑4272.

Thank you for your continued partnership.