|March MedicAide Newsletter Now Online|
The March 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.
|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 in each document. The updated documents are:
- Agency Professional
- Ambulatory Health Care Facility
- Ambulatory Surgical Centers
- General Billing Instructions
- General Information and Requirements for Providers
- Home Health and Hospice Services
- IHS, FQHC and RHC Services
- Therapy Services
- TPR Carrier Codes
|Medicaid Expansion Payment Delay|
Payments to Medicaid providers for services rendered to Medicaid Expansion participants will be delayed by at least one week. You will see full payment for these services just as soon as we can process the payment files. Any claims that are impacted will remain in a WAIT PAY or WAIT REVERSE status until payments are released. Any denied claims will be allowed to process and finalize. The payment delay is due to an unanticipated temporary shortfall in the state budget for expansion members. Resolution of this problem is currently underway and we appreciate your patience and understanding.
This delay in payment will NOT impact claims payments for services rendered to all other Medicaid participants, including Medicaid waiver participants. Healthy Connections case management payments will not be impacted. We expect extremely minimal or no impact to home and community based services provided to people with disabilities such as personal care services or in-home developmental disability services. Payments to providers through the Idaho Behavioral Health Plan, Idaho Smiles, Idaho Medicaid Plus and the Medicare-Medicaid Coordinated Plan, and non-emergency medical transportation payments through MTM will not be impacted in any way. If you have questions please call the Gainwell Technologies provider services at 1(866) 686-4272. Thank you for serving Medicaid participants.
|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 in each document. The updated document is:
|Attention Home Health and PCS Providers – EVV Data to be Reported|
Sandata is ready to begin the testing process with providers! Contact Sandata by phone at (855)545-1581 or via email at IDAltevv@sandata.com to initiate the process. Include the following when contacting Sandata:
- Provider ID
- Provider Name
- Provider Contact
- Provider Contact Title
- Provider Contact Email
- Provider Contact Phone
- Provider Address
- EVV Vendor Name
- Vendor Contact
- Vendor Contact Title
- Vendor Contact Email
- Vendor Contact Phone
EVV data must be reported and provided through your chosen and designated EVV vendor no later than July 1, 2021. Vendor testing is in process and providers are encouraged to implement their EVV system beginning in March. Claims for impacted services that are submitted beginning in March will PEND. If the claim is submitted without a matching EVV record, the claim will be set to a WARN status. If a EVV record can be found the claim edit will be set to an OKAY status. It’s vital that providers begin accurately reporting information for successful claim processing. Failure to comply will result in claim denials beginning on July 1, 2021.
|Healthy Connections Roster - Issue Identified |
Gainwell Technologies has identified an issue related to Healthy Connections Roster generation, which is impacting some larger providers. Our teams are working diligently to resolve the identified problem as quickly as possible. We will provide updates to this situation as we receive them, which will be communicated on our Announcements page. We thank you in advance for your patience.
|Provider Enrollment Application - Provider Support |
If you're experiencing an issue with navigating your application or if you're receiving an error message, please contact us by email at IDProviderServices@dxc.com or send secure message through your Trading Partner Account. Please include the following for an expedited resolution:
- A detailed description of the question, issue or error that you've encountered
- The username being utilized to access the Trading Partner Account
- A screenshot of the issue or error
- Pay-to NPI number and associated case number
- If the issue is related to a rendering provider, include the rendering provider's NPI and name
- If the issue is related to a license, Medicare Enrollment #, DEA, CLIA or Insurance update, include a copy of the credential
A response will be returned to your email message the same or next business day. If you'd prefer one-on-one assistance to walk through your new enrollment or maintenance application, please contact your Provider Relations Consultant (PRC). As always, we're happy to provide general assistance over the phone at 1(866)686-4272, option 1 for provider enrollment. Thank you for your continued patience.
|Changes to our Assistance Processes |
Immediate changes are being implemented by Gainwell Technologies with the support of the Idaho Department of Health and Welfare to ensure the highest level of security is reached. Gainwell is expecting providers to grant or authorize adequate levels of access to their respective staff, including billing agents or clearinghouses, to their Trading Partner Accounts for assistance with prior authorization status, claim submission, claim status details, payment reconciliation, and to perform secured messaging with Gainwell Technologies staff.
The following changes can be expected immediately when contacting a Gainwell Technologies representative:
- Prior authorization status and details will no longer be provided or confirmed verbally over the phone. Prior Authorization status can be verified by logging into your secure Trading Partner Account or by utilizing the Telligen portal.
- Claim information, such as claim numbers, status, or payment details will no longer be provided or confirmed verbally over the phone. Claim status and payment information can be verified or obtained by logging into your secure Trading Partner Account.
- Claim denial information will no longer be researched and verbally provided over the phone. A secure message can be sent to Gainwell by logging into your secure Trading Partner Account. A response will promptly be provided within 1 to 2 business days.
- Remittance Advice (RA) details should be obtained through the secure Trading Partner Account. If a provider has elected for a paper RA and needs an additional copy, a secure message can be sent to Gainwell by logging into your secure Trading Partner Account requesting an additional copy of the RA.
- Electronic Funds Transfer (EFT), including banking details will not be discussed verbally over the phone. A secure message can be sent to Gainwell by logging into your secure Trading Partner Account, when necessary.