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 Welcome to Health PAS-OnLine Announcements

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Provider Handbook UpdatesUse SHIFT+ENTER to open the menu (new window).

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:

  • Agency Professional
  • Ambulatory Health Care Facility
  • CMS 1500 Instructions
  • General Billing Instructions
  • General Provider and Participant Information
  • Hospital
  • Licensed Midwife
  • Overview
  • Physician Assistants, Advanced Practice Nursing
  • Podiatric Medicine and Surgery Services
  • Suppliers
  • UB04 Instructions
Provider Handbook UpdatesUse SHIFT+ENTER to open the menu (new window).

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:

  • ICD-9 and ICD-10 Diagnosis Billing Requirements (new document)
  • Speech, Language, and Hearing
Extended Maintenance Window August 29-30Use SHIFT+ENTER to open the menu (new window).

The Molina Medicaid website will be down from 12 p.m. on Saturday, August 29 through 2 p.m. on Sunday, August 30, 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.

Primary Code DiscrepancyUse SHIFT+ENTER to open the menu (new window).
Due to a clerical error in the annual rate change, certain primary care codes were entered at an erroneous rate.  This has been identified and the correction is in process.  Providers do not need to adjust their claims as Molina will be reprocessing all affected claims.  There is an estimated two-to-three week timeframe for corrections to be completed.  Thank you for your continued participation in the Idaho Medicaid program.
J7302 - Levonorgestrel-releasing Intrauterine Contraceptive System, 52 mgUse SHIFT+ENTER to open the menu (new window).

Effective September 1, 2015, Medicaid will begin paying for the FDA approved IUD, Liletta.  This product will share the same J-code (J7302) as Mirena.  Idaho Medicaid has established the reimbursement rate for each according to the Average Actual Acquisition Cost (AAAC) based on provider submitted invoices.  To ensure accurate reimbursement and for efficient claims processing, providers will need to append the UC modifier when billing for Mirena.  Liletta is to be billed using J7302 without the modifier.  Providers must still submit the NDC for the product actually used. 

Overpayment AdjustmentsUse SHIFT+ENTER to open the menu (new window).

For claims that are under two years from the last date of claim payment or adjustment, providers must adjust their own claims via an EDI 837 transaction or through their Trading Partner Account.  For those providers who do not have the capability to use either method, a Claim Review Request Form must be submitted stating in the Comments field why the provider is unable to adjust the claim electronically; additionally, the provider must also request that the claim be reversed, and include a new claim form with modifications along with the Claim Review Request Form, located on this website.

 

For providers seeking to adjust claims that are beyond two years from the last date of claim payment or adjustment, it is considered a recoupment.  For these claims, you must refund via check for both partial and complete recoupments and include the Overpayment Form located on this website.

ICD-10 Testing and InformationUse SHIFT+ENTER to open the menu (new window).

ICD-10 testing with Trading Partners continues through 9/16/15.  For more information or to register, see our test instructions and criteria.

 

MLN Connects National Provider Call:  Countdown to ICD-10

 

Register for a national provider call regarding ICD-10, offered by CMS on August 27.  The agenda includes:

  • National implementation update
  • Coding guidance
  • How to get answers to coding questions
  • Claims that span the implementation date
  • Results from acknowledgement and end-to-end testing weeks
  • Provider resources

Click here for more information or to register.

August MedicAide Newsletter Now OnlineUse SHIFT+ENTER to open the menu (new window).
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.
Medicaid ICD-10 Compliant!Use SHIFT+ENTER to open the menu (new window).
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.
FQHC/RHC Crossover and Third Party BillingUse SHIFT+ENTER to open the menu (new window).
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.
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