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Idaho Medicaid Health PAS OnLine

Online Help Help

  • Idaho Medicaid Program
    Health Coverage
    for Idaho families
  • Idaho Medicaid Program
    Health Coverage
    for Idaho families
  • Idaho Medicaid Program
    Health Coverage
    for Idaho families
    
Healthy Connections Rosters

​​​​The September Healthy Connections Rosters have been posted to your secure Trading Partner Account.​​​​​​​​ 

Attention Providers Licensed by the Idaho Board of Dentistry

​If you are a provider who is licensed by the Idaho Board of Dentistry and you renewed your license on or before September 30th Gainwell Technologies will automatically update the license information on your provider record and your participation in the Idaho Medicaid program will continue. Following your license expiration, you may see that your license expiration date was extended out in the enrollment system; this is to allow Gainwell the opportunity to reconcile the file from the board to your provider record.


If your license is renewed after September 30th, your license number is changed between the last and current renewal period or you have changed your name, and you wish to continue participating as an Idaho Medicaid provider, a maintenance must be completed on your record. If you are affiliated to a group, they must perform the maintenance on your behalf. Log into your Trading Partner Account at www.idmedicaid.com, hover over the “Account Maintenance” tab, and select “Provider Enrollment”. If you need any support completing the maintenance, contact your Provider Relations Consultant (PRC) for support.

Optum Idaho Annual Conference - Idaho's Behavioral Health Landscape

​Please join our valued partner, Optum Idaho, for their annual conference, held in-person or virtually October 18th and 19th. Additional details can be found on the invitation, select this link for more information.

Changes to Hospital Prospective Payment System: DRG

​Acute Care Hospitals will be subject to updates to the 3MTM All Patient Refined DRG (3M APR DRG) Software reimbursement methodology effective October 1, 2022. This update will result in changes to base rates and policy adjusters, the incorporation Graduate Medical Education (GME) reimbursement into the DRG reimbursement methodology, the transition from a charge-based outlier payment to a cost-based outlier payment, and the establishment of an interim billing process. This change will not affect Critical Access hospitals, State-owned hospitals, and Institutions for Mental Disease.  

Claim Denials and Secure Message Inquiries
If you're sending a Secure Message to Gainwell regarding claim denials and you have multiple claims denying for same reason or edit, please only send one Secure Message with claim numbers. This will allow us to address your issue in a prompt and timely manner and reduce the number of inquiries you have outstanding with us.
 
As a reminder, if you're needing to check the status of a claim you can do so without sending a Secure Message to us! You can quickly obtain this information by using the View & Submit Claims tile found on your Form Entry page. Use the Search icon to the right of the screen and enter at least two pieces of search criteria to narrow your search. The denial or payment information can be viewed here.  
Update Gainwell's Contact Email Addresses in Your Address Book!

On September 30, 2022 all mail-forwarding that was in place for @dxc emails to forward onto @gainwelltechnologies boxes will end. It is critical for you to update your contact information for Gainwell email addresses in order for us to best assist you! For our up-to-date contact information, please visit our Contact Information page.

As a reminder, it's best to send any HIPAA sensitive messages or inquiries to Gainwell using your secure Trading Partner Account. Simply sign into your TPA, hover over the File Exchange tab and select Messages/Alerts or select the Secure Messaging link from the Form Entry tab to access this feature. 

Dial 1 When You Call!
It is very important that you dial a 1 when calling us. Please call 1(866) 686-4272. Thank you! 
Welcome to the Idaho Gainwell Technologies Online Portal for Medicaid Providers!


This website provides information to Idaho Medicaid providers, trading partners, and the public. Helpful documents and links can be found in the menu bar above. 

 Scheduled System Downtime
​The Idaho Medicaid website is down each week from 4 PM on Saturday to 10 AM on Sunday for regular maintenance.  During this time, eligibility inquiries are available through our telephone system at 1 (866) 686-4272.  Any changes to this standard maintenance window will be communicated via an announcement on this website. 

 Provider Enrollment Information

Children's DD Independent Respite and–or CBS Provider Enrollment Instructions
CHIS Independent Intervention Specialist and Intervention Professional Provider Enrollment Instructions
Maintenance User Guide – Facility Agency Organization
Maintenance User Guide – Group
Maintenance User Guide – Individual
New Provider Enrollment User Guide – Converting from an ORP to an Individual Provider
New Provider Enrollment User Guide – Facility Agency Organization
New Provider Enrollment User Guide – Group
New Provider Enrollment User Guide – Individual
New Provider Enrollment User Guide – Ordering Referring Prescribing Provider (ORP)
PEA Top Issues
PEA Top Tips and Tricks
Prospective Provider Toolkit – Personal Assistance Agency
Provider Enrollment User Guide – Disenrollment
Provider Enrollment User Guide – Reactivation

 COVID-19
Official Resource for Novel Coronavirus(COVID-19) :
https://coronavirus.idaho.gov/resources-for-healthcare-providers
Information Releases :
/Lists/Information%20Releases/AllItems.aspx

 Claims Processing


Paper claims must be received by 5:00 P.M. Monday in order to be included in the next regular weekly payment processing cycle.

Electronic claims must be received by 8:00 p.m. Thursday to be included in the next regular weekly payment processing cycle.

Click here to view the 2022 Financial Payment Processing Cycles.

 Trading Partner Account Login

Click here to sign in to your secure Trading Partner Account.  By logging into the secure portal, you can view eligibility, view and submit claims, manage patient rosters, perform enrollment and maintenance, view authorizations, download reports, and more. 

 Gainwell Technologies Partners
Click here for a list of contact information for our valued partners. 
Attention Providers Licensed by the Idaho Board of Dentistry
If you are a provider who is licensed by the Idaho Board of Dentistry and you renewed your license on or before September 30th Gainwell Technologies will automatically update the license information on your provider record and your participation in the Idaho Medicaid program will continue. Following your license expiration, you may see that your license expiration date was extended out in the enrollment system; this is to allow Gainwell the opportunity to reconcile the file from the board to your provider record.

If your license is renewed after September 30th, your license number is changed between the last and current renewal period or you have changed your name, and you wish to continue participating as an Idaho Medicaid provider, a maintenance must be completed on your record. If you are affiliated to a group, they must perform the maintenance on your behalf. Log into your Trading Partner Account at www.idmedicaid.com, hover over the “Account Maintenance” tab, and select “Provider Enrollment”. If you need any support completing the maintenance, contact your Provider Relations Consultant (PRC) for support.
Attention! Behavioral Health Providers

​If you are a provider who is enrolling or enrolled as a Mental Health Clinic, Rehabilitative Mental Health Service provider, Mental Health Case Management provider or any other provider that renders behavioral health services, you may also be required to enroll and maintain your provider record with Optum Idaho. For more information, contact Optum. Regional Network Managers can assist you and are listed on the Regional Representation Flyer found at www.OptumIdaho.com > Contact Us tab. 

 Idaho Medicaid Member Resources
​Participant Services Phone ​1 (866) 686-4752 (Toll-free), 1 (208) 373-1432 (Local)
​Participant Services E-mail ​idparticipantservices@gainwelltechnologies.com
​Participant Information Website https://healthandwelfare.idaho.gov/services-programs/medicaid-health
​Language Services ​http://healthandwelfare.idaho.gov/AboutUs/LanguageAssistance/tabid/3766/Default.aspx
​Idaho Health Plan Coverage Booklet - English ​ https://publicdocuments.dhw.idaho.gov/WebLink/DocView.aspx?id=2080&dbid=0&repo=PUBLIC-DOCUMENTS
​Idaho Health Plan Coverage Booklet - Spanish ​ https://publicdocuments.dhw.idaho.gov/WebLink/DocView.aspx?id=2081&dbid=0&repo=PUBLIC-DOCUMENTS

 Gainwell Technologies Contacts
​Gainwell Provider Relations Consultants Contact Information
​Idaho Medicaid Contact Information (Provider Services, Provider Enrollment, and Gainwell partners)

 

 Resources & Links
Provider Handbook
​MedicAide Newsletters
​Medicaid Fee Schedules
​User Guides
​Information Releases

 
 

Provider Training
Opportunities

Click here to view the Training Calendar and browse upcoming training opportunities.  Please log into the Idaho Medicaid Training Center to register for training sessions. 

For training support, contact IDTraining@gainwelltechnologies.com.