After recent review of our bariatric surgery policy, effective for date of service April 1, 2015, bariatric procedures may now be performed in any Idaho Medicaid enrolled hospital which is also Medicare certified.
We have completed successful validation of ICD-10 updates to our Molina claims processing system (MMIS) for ICD-10 compliance with an effective date of 10/1/2015. ICD-9 coded claims are required for dates of service through 9/30/2015. Starting 10/1/2015, all claims with a date of service of 10/1/2015 and later are required to be billed with ICD-10 codes.
The March 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.
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
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.