As of 6/30/2015, certain CPT/modifier combinations were termed in error. This is causing some claims to deny incorrectly for an invalid modifier. The CPT/modifier combinations have been identified and we are working to reactivate them as soon as possible. Any affected claims will be reprocessed once the issue has been resolved. We apologize for the inconvenience.
Updates have been made to the General Provider and Participant Information 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.
Idaho requires prior authorization for certain Physician Administered Drugs (PAD). The list of PADs that do require PA is updated quarterly. The list has been updated for the third quarter of 2015, and is now available at www.medunit.dhw.idaho.gov under "Resources."
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.
Local ICD-10 training offerings:
A two-day ICD-10 training will be offered this year at the Idaho Health Care Association 49th Annual Convention & Tradeshow on 7/21/15 and 7/22/15. Click here for registration information and the full schedule of events.
The numerical fee schedule has been updated and is available online. Click Medicaid Fee Schedules in the menu on the left to view the most current ones. The numeric fee schedule is applicable to most providers. Additional custom fee schedules are updated as needed.
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.
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.
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.