Updates have been made to the Provider Handbook. You may find the link on the left navigation panel of this website. Changes are noted at the beginning of each document. The updated documents are:
CMS 1500 Instructions
This notice is to advise Idaho Medicaid Providers of the current decision regarding coverage of the 2015 new CPT laboratory codes after date of service 2/28/2015. Effective 3/1/2015, Idaho Medicaid will not cover the new 2015 laboratory codes 80300 through 80377 (63 codes) until Medicare pricing is available. For claims billed for dates of service prior to 3/1/2105, and using CPT® codes 80300 – 80377, an invoice is required to be attached. This is to enable pricing for the new CPT® codes which do not currently have a price on file.
CMS has created a series of G-codes with pricing that may be used in place of the 80300 – 80377 CPT® codes effective 1/1/2015. For dates of service 3/1/2015 and after, Idaho will require providers to use the appropriate HCPCS® code within the G-code series available on the March 2015 Fee Schedule. An invoice is needed only if no price is listed on the Numerical Fee Schedule. Please refer to our website for the current Numerical Fee Schedule.
The Workgroup for Electronic Data Interchange (WEDI) is conducting an ICD-10 readiness survey to determine how well the healthcare industry is progressing toward the October 1, 2015 implementation deadline.
You can complete the survey no later than 3/6/2015 by visiting https://www.surveymonkey.com/s/ICD10-survey.
The survey results will be evaluated and compiled into a report for the industry, which we expect to release mid-March. Providers, health plans, vendors, and clearinghouses are invited to participate in this important initiative to help monitor progress as we move closer toward the implementation deadline.
The dates have been announced for the 2015 Idaho Health Care Conference. Look for more details soon on www.idmedicaid.com.
Clarkston – May 5, 2015
Coeur d’Alene – May 6, 2015
Idaho Falls – May 12, 2015
Pocatello – May 13, 2015
Twin Falls – May 14, 2015
Boise – May 21, 2015
The February 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.
Beginning January 1, 2015 Medicaid will implement an edit in the claims processing system that will look at inpatient claims for Health Acquired Conditions (HAC). The system will use the combination of the Present on Admission (POA) indicator, procedure codes, and diagnosis codes. The POA indicator is required for all claims involving Medicaid inpatient admissions.
POA is defined as present at the time the order for inpatient admission occurs — conditions that develop during an outpatient encounter, including emergency department, observation, or outpatient surgery, are considered POA. The POA indicator is assigned to principal and secondary diagnoses.
For details and proper billing, refer to the Provider Handbook – Hospital (https://www.idmedicaid.com/Provider%20Guidelines/Hospital.pdf) Section 4.4 – 4.4.2.
Any claim that is not properly billed will be denied.
In order to be paid up to the Encounter Rate for claims with a third party payment, specific instructions must be followed. Click here for the instructions.
We have posted a trading partner registration ‘Tip Sheet’ to answer questions you may have concerning which entity type to select. You can find it under the ‘User Guides’ link to your left.
It is very important that you dial a 1 when calling us. Please call 1 (866) 686-4272.