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Idaho Medicaid Health PAS OnLine

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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
    
Veteran's Day Holiday and the Financial Cycle New
Due to the Veteran's Day holiday, the financial cycle for the week of 11/9/2018 will be delayed by one day. Payments, Remittance Advices (RAs), and the HIPAA 835 Claim Advice Files will be one day later than normal.
Healthy Connections Rosters

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

Retroactive Share of Cost

​The Department is changing the way it collects overpayments/adjusts underpayments due to retroactive Share of Cost (SOC) changes. SOC that has changed for previously paid claims will need to be adjusted by reprocessing the impacted provider claims. Any provider serving a member that has had an SOC change will be notified via a letter. The letter will identify the dates associated with the change, the newly calculated amount and instructions on what will or needs to be done. Because these changes can result in a decrease or an increase in the member’s SOC, it will be the providers’ responsibility to reconcile with the member for any SOC collected. If you have any questions about this notification, please contact your Provider Relations Consultant.

Provider Handbook Updates

​Updates have been made to Provider Handbooks to reflect the purchase of Molina Medicaid Solutions by DXC Technology. To review the changes, select the link under the Reference Material menu on this webpage. Changes are noted at the beginning of each document.

November MedicAide Newsletter Now Online

​The November 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.​​​​​​

Idaho Medicaid Plus
Idaho Medicaid Plus (IMPlus) is in full swing in Twin Falls County! IMPlus is a mandatory program for dual eligible Medicare/Medicaid participants that coordinates most of their Medicaid benefits through Blue Cross of Idaho or Molina Healthcare of Idaho. Providers should check eligibility in the HealthPAS provider portal to verify which health plan dual eligible participants have selected.
Ordering, Referring, Prescribing (ORP) Providers Report Available

Your provider Trading Partner Account (TPA) now offers a report listing all Idaho Medicaid Ordering, Referring, and Prescribing (ORP) only Providers. To generate a list of ORP providers:

·  log into your secure Trading Partner Account

·   select the Provider Directory drop down

·   then select ORP Report

 

You can search, print the list, or export to excel. Please read the informational notice provided with the report as it contains specific details about the report, use and clarification.

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.
 

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 DXC Technology 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. 

 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. 

 DXC Technology 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-mail​idparticipantservices@molinahealthcare.com
​Participant Information Websitehttp://www.healthandwelfare.idaho.gov/Home/tabid/55/Default.aspx
​Language Services​http://healthandwelfare.idaho.gov/AboutUs/LanguageAssistance/tabid/3766/Default.aspx

 Molina Contacts
​DXC Technology Provider Relations Consultants Contact Information
​Idaho Medicaid Contact Information (Provider Services, Provider Enrollment, and DXC Technology 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@MolinaHealthcare.com.