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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
    
Attention: Certified Family Home Providers – Rate Changes for Aged & Disabled Waiver Participants
Certified Family Home (CFH) providers who provide care to participants on the Aged & Disabled waiver must reprocess any claims that were submitted for dates of service on or after April 1, 2023 to receive the new S5140 daily rate. CFH providers may adjust and correct claims that were billed to Gainwell Technologies (GWT), Blue Cross of Idaho or Molina Healthcare of Idaho.
  • For claims processed by GWT, Certified Family Home providers must adjust their claims for dates of service 04/01/2023 and any dates after to add the new prior authorization number in order for the rate increase to be applied to the claims already submitted.
  • For claims processed by Blue Cross of Idaho and Molina Healthcare of Idaho, you will receive communication directly from the managed care vendor on how to proceed.
  • New prior authorizations with updated daily rates will be issued by June 1, 2023. When available, they can be viewed online through the View Authorization tile.
  • When adjusting your claim, be sure to modify the billed charges and the prior authorization number. Tips on adjusting your claim can be found here.  
  • For support with the necessary adjustments, you may contact your Provider Relations Consultant – their contact information can be found here.
Eligibility Verification Reminder

During the Public Health Emergency (PHE) the Families First Coronavirus Response Act kept Medicaid enrollees from being disenrolled from coverage, while the PHE was in force. As a result of the PHE unwinding, Medicaid coverage for individuals who were qualified in this manner may be ending. Idaho Medicaid re-evaluation for participant eligibility is underway.

IDHW is responsible for determining eligibility and any Medicaid participant who has questions should be directed to contact Self Reliance at 1(877)456-1233. Gainwell is not able to address eligibility qualification questions.

Gainwell Technologies is encouraging all providers to diligently review the participant's eligibility on the date of service by verifying their coverage online at www.idmedicaid.com through the secure provider portal, using the Medicaid Automated Customer Service (MACS) line by calling us at 1(866)686-4272 or by sending a Secure Message to us using the provider portal if you have any questions on what is returned on the eligibility information.

Attention All Hospital and Long Term Care Facility Provider Types! Additional Terms Documentation

​An enhancement to the Provider Enrollment Application and the current process in collecting Additional Terms documentation for Hospitals reimbursed using 3MTM All Patient Refined DRG (APR DRG) Software and Long Term Care Facility provider types is moving through our implementation process and we anticipate this change to have provider impact by 05/01/2023. Many providers have already completed the Additional Terms documentation, however, we must require Hospital and Long Term Care Facilities to repeat their acknowledgement and electronically sign the terms that are presented on the Documents tab in the application during their next maintenance. If a change in ownership is reported the Additional Terms will require re-acknowledgement. Thank you for your cooperation in this matter.

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

Enrollment Instructions for Independent Intervention Specialist and Professional Providers
Enrollment Instructions for Independent Respite and CBS Providers
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

 ‭(Hidden)‬ 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 2023 Financial Payment Processing Cycles.

Medicaid Fraud, Abuse and Misconduct Video

Medicaid Fraud, Abuse and Misconduct. Link

 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 All Hospital and Long Term Care Facility Provider Types! Additional Terms Documentation

​An enhancement to the Provider Enrollment Application and the current process in collecting Additional Terms documentation for Hospitals reimbursed using 3MTM All Patient Refined DRG (APR DRG) Software and Long Term Care Facility provider types is moving through our implementation process and we anticipate this change to have provider impact on 5/1/2023. Many providers have already completed the Additional Terms documentation, however, we must require Hospital and Long Term Care Facilities to repeat their acknowledgement and electronically sign the terms that are presented on the Documents tab in the application during their next maintenance. If a change in ownership is reported the Additional Terms will require re-acknowledgement. Thank you for your cooperation in this matter.

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.