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  • Idaho Medicaid Program
    Health Coverage
    for Idaho families
  • Idaho Medicaid Program
    Health Coverage
    for Idaho families
  • Idaho Medicaid Program
    Health Coverage
    for Idaho families
    
Intra-Agency Agreement for Early Intervention Services New

The Infant Toddler Program and Idaho Medicaid launched a new model for early intervention services under Early Periodic Screening and Diagnostic Services (EPSDT), effective July 1st for children (ages birth up through 36 months) eligible for Medicaid, who have a development delay or who are at risk of developing a developmental delay, to receive medically necessary screenings.   The Intra-Agency Agreement for Early Intervention Services  which supports the agreement between the Division of Family and Community Services and the Division of Medicaid is now available in the Links section of the Provider Handbook under the Resources tab on the Molina Medicaid Provider Portal. Guidance for providers is available in the General Provider and Participant Information handbook, in the Early Intervention Services section.  You can also find more information in the June edition of the MedicAide Newsletter.

Resolved: Molina Provider Portal Reversal Claims Issue New

The adjustment or reversal claim issue that some providers were experiencing has been resolved. Thank you for your patience while Molina worked to resolve the issue.

PERM Audit - Improper Payments to be Recouped

Have you received a request for records from the Payment Error Rate Measurement (PERM) program? This program measures improper payments in Medicaid; auditors must review medical records. If providers do not submit the medical records requested by PERM auditors, the claim payment will be considered an improper payment. Without the requested records there is no evidence for auditors to determine whether the services were provided, were medically necessary and were properly coded and paid. Idaho Medicaid must recover any improper payments made to providers.

Failure to provide requested documentation for claim payments is a violation of Idaho Code Section 56-209h and the Idaho Medicaid Provider Agreement. Providers contacted by PERM auditors must respond with the requested records in the timeframe indicated.

For more information about PERM, please see the June 2018 MedicAide newsletter or our Frequently Asked Questions at: https://www.idmedicaid.com/Lists/FAQs/Current.aspx.
 

Continuous Glucose Monitoring Devices

Effective October 1st, 2018, prior authorization requests for CGM’s must be submitted on the Idaho Medicaid Continuous Glucose Monitoring (CGM)/Supply Prior Authorization Form. This form is currently online on the DME website under the Forms section. To ensure Idaho Medicaid is aligned with CMS guidelines and federal coding requirements, therapeutic models must have K0553 and K0554 codes submitted on PA requests. Non-therapeutic models must be submitted with A9276, A9277, A9278 codes. Idaho Medicaid only covers the DeXcom G5 continuous glucose monitor (CGM) per the guidance of CMS ruling CMS-1682-R. The DeXcom G5 model is the only model authorized through CMS/Medicare as a therapeutic device. The DeXcom G6 model will not be authorized. Idaho Medicaid’s medical necessity criteria for DME is set forth by the CMS/Medicare Jurisdiction D Manual.

Healthy Connections Rosters

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

Provider Handbook Updates

​Updates have been made to the Provider Handbook. You may find the link under the Reference Material menu on this website. Changes are noted at the beginning of each document. The updated documents are:

  • TPR Carrier Codes
September MedicAide Newsletter Now Online

​The September 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 Vision Program Administrator

Effective October 1, 2018, National Vision Administrators (NVA) and Classic Optical, its partner optical laboratory, will be administering the eyeglass and contact lens vision supplies for State of Idaho Medicaid members.

Classic Optical will continue to manufacture the lenses, however all lab orders and request for prior approvals will be administered by NVA. NVA will be sending additional information out to optical providers in the coming weeks. If you have questions, please contact Cody Cockrum, IDHW Program Specialist: Cody.Cockrum@dhw.idaho.gov or 208-334-5747

Attention Providers Submitting Secondary Claims through Your Trading Partner Account

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.

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 Molina 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 Molina 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. 

 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 2018 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. 

 Molina Partners

Click here for a list of contact information for our valued partners. 

 Idaho Medicaid Member Resources

​Participant Services Phone​1 (866) 686-4752 (Toll-free), 1 (208) 373-1432 (Local)
​Participant Services E-mailidparticipantservices@molinahealthcare.com
​Participant Information Websitehttp://www.healthandwelfare.idaho.gov/Home/tabid/55/Default.aspx
​Language Serviceshttp://healthandwelfare.idaho.gov/AboutUs/LanguageAssistance/tabid/3766/Default.aspx

 Molina Contacts

Molina Provider Relations Consultants Contact Information
Idaho Medicaid Contact Information (Provider Services, Provider Enrollment, and Molina partners)

 

 Resources & Links

 

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@MolinaHealthcare.com.