IRS form 1099‐MISC, Miscellaneous Income, for tax year 2016, will be mailed to providers before January 31, 2017. For more information, see our Frequently Asked Questions.
The January 2017 Idaho Medicaid Fee Schedule posting has been delayed. Idaho Medicaid will post the Fee Schedule once the update of new codes and fees is complete. We anticipate this information to be available by February 1, 2017.
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
- Speech, Language, and Hearing
- Therapy Services - Occupational and Physical (formerly Respiratory, Developmental, Rehab, Restorative Services)
The Respiratory, Developmental, Rehab, Restorative Services section of the Provider Handbook has been renamed. Please refer to the document named Therapy Services – Occupational and Physical going forward.
The January Healthy Connections Rosters have been posted to your secure Trading Partner Account.
The January 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.
New 2017 Evaluation and Re-evaluation Codes
Effective January 1, 2017, there are three new evaluation procedure codes for PT (97161, 97162, 97163) and three new codes for OT (97165, 97166, 97167). The new codes are based on patient complexity and level of clinical decision-making of low, medium and high complexity. One new re-evaluation procedure code for each therapy type were also introduced; PT 97164 and OT 97168. Codes in current use for 2016 will be discontinued as of December 31, 2016.
Providers must use the detailed long description of each new evaluation code to correctly code claims and to ensure accurate reporting of services rendered based on documentation in the participant’s file. The therapist performing the evaluation or re-evaluation must ensure that all components of the billed code are accomplished. While there is a usual time component for each of the codes, to bill a specific code, all listed components must be completed and documented.
If components of an evaluation are divided into separate sessions or separate days, it is still one evaluation, and providers may not bill multiple evaluations for the additional sessions.
Providers should consult the CMS MLN Matters Number: MM9782 for more information and the long description of each new code.
If a participant has primary insurance and their primary insurance claim has denied or paid at zero, providers must enter the Coordination of Benefits information in the COB Information section of the claim in addition to uploading the primary insurer's Explanation of Benefits (EOB). The EOB must include the EOB summary page. If the primary paid amount is zero, providers must enter zero and enter the paid date as the date of the EOB. If reporting both a co-pay amount and a coinsurance amount, these need to be added together and entered under coinsurance. These steps must be followed in order for us to process your claim correctly.
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.
It is very important that you dial a 1 when calling us. Please call 1 (866) 686-4272.