The October Healthy Connections and Idaho Medicaid Health Home Member Rosters have been posted to your secure Trading Partner Account.
Due to the Columbus Day holiday, the financial cycle for the week of 10/12/2015 will be delayed by one day. Payments, Remittance Advices (RAs), and the HIPAA 835 Claim Advice Files will be one day later than normal.
Updates have been made to the Suppliers section in the Provider Handbook. You may find the link on the left navigation panel of this website. Changes are noted at the beginning of the document.
All Physician and Midlevel Practitioners: New National Correct Coding Initiative (NCCI) Edits will be implemented October 1, 2015. Included in the edits are a number of procedure-to-procedure (PTP) edits for catheter insertion. When a provider bills for a catheter insertion, they may not also bill for the catheter used. The supply is bundled into the service provided.
The October 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.
ICD-10 diagnosis codes are now required on ALL claims with a date of service of 10/1/2015 and later. ICD-9 diagnosis codes continue to be required on ALL claims for dates of service of 9/30/2015 or earlier.
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:
Allopathic and Osteopathic Physicians
General Billing Instructions
General Provider and Participant Information
Nursing and Custodial Care Facilities
Modifiers are used to increase accuracy in compensation, coding consistency, editing, and to capture payment data. At times, reviewers for Idaho Medicaid may attach a modifier to a procedure code when a PA is approved.
When providers receive notification of an approved PA, it is essential to check the authorization to determine if a modifier is attached to any of the approved procedure codes. If there is a modifier attached to the approved PA, that modifier must be used when billing for the service. The absence of an approved modifier will result in a claim denial.
Effective October 1, 2015, Idaho Medicaid will cover a new CMS established code. The new code is: Q9979 Injection, Alemtuzumab, 1 mg. This code will require prior authorization (PA).
Also effective October 1, 2015, Idaho Medicaid will require a prior authorization for four other codes which previously did not require a prior authorization:
J1931 INJECTION, LARONIDASE, 0.1 MG;
J3262 INJECTION, TOCILIZUMAB, 1 MG;
J1290 INJECTION, ECALLANTIDE, 1 MG; and
INJECTION, C-1 ESTERASE INHIBITOR (HUMAN), BERINERT, 10 UNITS.
The complete list of Physician Administered Drugs Requiring PA for Idaho Medicaid can be found at the website below on the right-hand side of the page under Resources.
The updated Idaho State Transition Plan for Home and Community Based Service Settings is now posted for public comment at www.HCBS.dhw.idaho.gov. Comments will be taken through midnight, October 12, 2015.