| | Update – URGENT – Duplicate Deposits – Withdraw and Future Potential Impacts | | The Idaho Department of Health and Welfare was made aware that the State Treasurer's Office is working with the State Controller's Office to initiate a reversal file, which should withdraw the duplicate transaction funds from the respective provider accounts today, Friday, December 1st or Monday, December 4th. Confirmation on the successful reversal will be released in a future communication. During the investigation into the duplicate deposit issue, it was discovered that additional work and solutioning is needed in the LUMA system to prevent any further delay in payments for some providers. Gainwell and IDHW are aware that additional payment delays could occur in the next financial cycle and want to ensure that providers are informed that work is being done to rectify and correct this issue. Thank you for your patience in this matter. |
| | December MedicAide Now Online | | The December edition of the MedicAide Newsletter is now available online. Please click here for the latest news and information affecting Idaho Medicaid providers. |
| | Update – URGENT – Duplicate Deposits | | The Department of Health and Welfare is working closely with all financial partners to investigate the issue and identify a root cause that resulted in two deposit payments for several Idaho Medicaid Providers for the claims included in the 11/28 payment. Those involved with resolving this matter believe they have identified a solution and will be diligently processing the next payment file to prevent this issue from reoccurring. The financial partners are actively working through a bank recovery solution; additional details regarding the timeline and process for the recovery process will be communicated here, in the Announcements, as they are made available. Thank you for your patience in this matter. |
| | Trading Partner Account Cleanup | | Beginning December 11, 2023, in an effort to enhance security, Gainwell Technologies will begin to evaluate all Trading Partner Account users and terminate those user accounts that have not been active for the past 365 days. A notification will be sent to the email address associated to the user whose account has been identified for termination 30 days prior to the termination taking place. Following the termination another notification will be delivered. If a user receives the notification and wishes to have their account remain active, they should simply login to their account. If a user's account was terminated and access needs to be restored, their Trading Partner Account Administrator must invite them back to the account. For any questions, please contact us by phone Monday-Friday from 7:00 AM to 7:00 PM MST. |
| | Help Gainwell Help You | | Gainwell’s goal is to offer quick, efficient support in one interaction. We are asking to partner with the provider community to ensure adequate levels of access and training is made available to their respective staff, including billing agents or clearinghouses. We have identified many messages coming into our staff without enough information for us to resolve in one interaction; this is causing more traffic and longer resolution times for us to support you. By establishing the level of access and understanding an individual may need to support the provider's office, Gainwell will have greater ability to interact and offer the best support to assist in complex claim, eligibility, or enrollment questions. We encourage you to engage with us via phone Monday-Friday from 7:00 AM to 7:00 PM MST, schedule a meeting with your Provider Relations Consultants or send us a secure message through your portal when assistance is needed. As a reminder, when communicating with us via secure message: - Limit inquiries. If you have multiple claims for the same participant, include them all in one secure message rather than sending one message for each claim. Please provide no more than five claims numbers per inquiry.
- Provide your claim number(s). You can look up a claim number by navigating to your View & Submit Claims tile by using the Search button and entering search criteria.
- Provide enough information for us to assist and resolve the question in the first secure message that is sent to us. Each message should include your pay-to or billing NPI or atypical provider ID and name of the provider and your question or concern. Include the following, based on the type of message you are sending:
- Claims
- Claim number or
- Pay-to or billing NPI and name of the provider, participant's Medicaid ID number and full name, the date of service and billed amount.
- Eligibility
- Participant's Medicaid ID number and name, the date of service(s), and service codes (CPT, HCPCS, and/or Revenue)
- For Prior Authorization (PA): Participant's Medicaid ID number and name, the PA request date, date of service(s) the PA was requested for, and service codes.
- EDI
- Claim submission date, claim number(s) (if on file), participant's Medicaid ID number and full name, the date of service and billed amount.
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| | Did You Know? Empowering Through Self-Service | | Did you know that each billing provider that is enrolled with Idaho Medicaid is able to establish a secure Trading Partner Account (TPA) on the provider portal, which offers multiple resources and tools, on demand, for quick resolutions? We are happy to share more information with you! Our goal is to empower the provider community with the tips and tools they need, when they need them. The Trading Partner Account (TPA) User Guide provides specific instruction on how to: verify eligibility, utilize the patient roster, access payment details, view or submit referrals, look-up a prior authorization, view claim status and even submit or adjust claims directly on the portal. The tool is user friendly and if any specific training is needed, Gainwell's Provider Services Representatives are trained and standing-by to assist you with navigating the portal. Did you know that you can refer to the Remittance Advice Analysis and Top Claim Denial Reasons reference materials as resources that may better explain how to interpret the remit details and the reason a claim was denied? We encourage all providers to familiarize themselves with the Remittance Advice and any claim denial; providers only have two years from the start date of service to make corrections or adjustments to their claims. Did you know that our Frequently Asked Questions page has helpful topics and answers, along with our Best Practice reminders? The MedicAide Newsletter is released at the beginning of each month and serves as direct communication with the provider community regarding reminders, changes to policy, training opportunities and other tips to support the Idaho Medicaid program. We appreciate the opportunity to partner with the Idaho Medicaid provider community. Both the Idaho Department of Health and Welfare and Gainwell Technologies would like to thank you for the important work you do to help Idahoans and our community. |
| | Secure Messaging – New Message | | PLEASE NOTE: Secure Message threads that began prior to 8/29, the date of the contact center platform upgrade, will NOT be delivered to Gainwell. Please start a new message; you can attach the prior correspondence as an attachment, if needed. As a reminder, to route your inquiry appropriately you can select the Topic from the New Message window. Include the necessary details in your message: - Each message should include your pay-to or billing NPI or atypical provider ID and name of the provider and your question or concern. Include the following, based on the type of message you are sending:
- Claims
- Claim number or
- Pay-to or billing NPI and name of the provider, participant's Medicaid ID number and full name, the date of service and billed amount
- Eligibility
- Participant's Medicaid ID number and name, the date of service(s), and service codes (CPT, HCPCS, and/or Revenue)
- For Prior Authorization (PA): Participant's Medicaid ID number and name, the PA request date, date of service(s) the PA was requested for, and service codes
- EDI
- Claim submission date, claim number(s) (if on file), participant's Medicaid ID number and full name, the date of service and billed amount.
We appreciate the opportunity to partner with the Idaho Medicaid provider community. Thank you for the important work you do to help Idahoans become as healthy and self-sufficient as possible. |
| | Attention All Providers – Contact Center Platform Upgrade Requires Provider Action | | Gainwell has partnered with the NICE CXone platform to manage our contact center areas and we are planning to implement within the coming days. Provider action will be necessary, as noted below in this communication. Once implemented, all interactions that occur through our Medicaid Automated Customer Service (MACS) line, including self-service and discussions with our agents, as well as all secure message and email interactions you have with us, will be managed in this tool. We are excited to leverage an enhanced platform to provide our teams with capabilities to increase their productivity and the quality of how we are able to interact with the Idaho Medicaid provider and participant community.
On August 29th, upon implementation to this new platform, all billing providers will hear a recorded message that instructs them to set the new four-digit security code. This code is used to access information within the MACS system. To set the security code, the Social Security Number or Tax ID must be entered into the system. Press the # sign to be routed to the Change Security Code menu. Listen closely to the prompts and set the new four-digit security code.
Gainwell encourages all billing providers to communicate this code and change within their organizations so we can best assist when they contact us over the phone.
If you encounter any issues when resetting the security code, please dial 0 or speak “rep” and hold on the line to be connected to a representative for support.
Thank you for your cooperation and engagement on this matter.
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| | 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!
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