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Welcome to Idaho Medicaid

 Announcements

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5/16/2017
April 2017 MedicAide ORP CorrectionUse SHIFT+ENTER to open the menu (new window).

Attention providers, Medicaid would like to make a correction to the article released in the April 2017 MedicAide. Claims that require an ordering, referring, or prescribing provider's name and NPI, WILL NOT deny on May 19.

 

The edit is set to warn as we work through different provider specialty concerns. Not all providers who are receiving the WARN edit today will have claims deny when we switch the edit to DENY. Please continue to watch for announcements and MedicAide articles as we move toward the final implementation.

5/11/2017
Ordering, Referring, and Prescribing (ORP) -Claims are NOT Denying NowUse SHIFT+ENTER to open the menu (new window).
The ORP edits are currently in WARN status, meaning no claims are currently being denied; however, once provider outreach has been completed we will turn the edits to DENY.  At that time, if the ORP provider’s name and the National Provider Identifier (NPI) are not listed on a claim, or if the ORP provider is not enrolled with Idaho Medicaid, the billing provider will not receive reimbursement. We do not yet have a firm date on switching the edit to deny. We want to be sure that we have taken the time to explain to the affected providers and work out any problems they may be having.  We will post an announcement at least one week before the edits are changed and claims begin to deny.
5/9/2017
Ordering, Referring, and Prescribing (ORP) RequirementsUse SHIFT+ENTER to open the menu (new window).

Idaho Medicaid requires the name and the National Provider Identifier (NPI) of the health care professional that ordered, referred, or prescribed (ORP) the items or services being submitted on a claim to Medicaid.  If the ORP provider’s information is not listed on a claim, or if the ORP provider is not enrolled with Idaho Medicaid, the billing provider will not receive reimbursement.  This means that health care professionals not currently enrolled with Idaho Medicaid will need to submit an application.  There is an abbreviated application process for providers who do not submit claims to Medicaid but who must enroll as ordering, referring, certifying, or prescribing providers.  The Ordering, Referring, and Prescribing Enrollment Application can be found here. 

 

Further details regarding this requirement were published in the April 2017 MedicAide newsletter.

5/1/2017
May MedicAide Newsletter Now OnlineUse SHIFT+ENTER to open the menu (new window).

The May 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.

4/10/2017
Once in a Lifetime Procedures and ModifiersUse SHIFT+ENTER to open the menu (new window).

Idaho Medicaid will reimburse certain procedures only once during a patient’s lifetime. Once in a Lifetime Procedures are not limited to a single CPT code, but may be represented by Code Families, which are a group of CPT codes that describe the same or similar type of service. For example, there are four separate appendectomy CPT codes that can be used based upon the particular circumstance, to report the removal of the appendix. Under this policy, Medicaid provides reimbursement for only one procedure from a designated Code Family during a patient’s lifetime.

 

When any health care professional reports a code from the Once in a Lifetime Procedures, that code or any code from the same Code Family will be reimbursed only once during a patient’s lifetime.

 

Additional information on this policy will be published in the May edition of the MedicAide newsletter.

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 5/15/2017 9:04 AM
 
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