|Attention: Provider Enrollment and Maintenance Staff |
August Workshops in Lewiston and Twin Falls!
Please join your Provider Relation Consultant as they share information on the upcoming Provider Enrollment Application (PEA) project and the current Trading Partner Account User Guide. This will be a wonderful time to learn about new features, how to best utilize our current Trading Partner Account resources and what you can do today to make sure your group is receiving communication and updates.
Our Two Venues:
Region 2 Lewiston
August 8th from 10-12
3rd floor conference room of the State building
1118 F Street, Lewiston ID
Region 5 Twin Falls
August 9th from 10-12
Conference Room A
601 Pole Line Road, Twin Falls ID
Limited spaces available. To register please click here.
|Medicaid Fee Schedule Updates |
Idaho Medicaid is aware of pricing errors on the July Fee Schedule. The fee schedule is being corrected and will be reposted. If your claim has paid at the incorrect rate, it will be reprocessed and paid at the correct rate. Providers do not need to take any action at this time.
|Health Information Technology Survey|
IDHW is working with its partner, Briljent, to conduct a survey on Health Information Technology in Idaho. Providers may have been contacted to participate in the survey. If you have been contacted, IDHW encourages you to participate in this important survey.
|Licensure Required for Sign Language Interpreters |
Effective July 1, 2018, sign language interpreters working in facilities, clinics, or agencies serving Medicaid participants must hold a valid license issued by the Idaho Bureau of Occupational Licenses. The 2017 Idaho Legislature amended IDAPA Title 54, Chapter 29 to implement this change. Enrolled Idaho Medicaid Providers have agreed to provide services in accordance with all applicable federal laws, and provisions of statutes, states rules and federal regulations; this is a reminder that the statute change has now gone into effect.
Idaho Medicaid providers who wish to bill for reimbursement for interpretive services, should review section 2.7 “Interpretive Services” of the General Provider and Participant Handbook for additional information. Please note that section 2.7.1 of the handbook states “Interpreters and translators must meet state and professional licensure requirements.”
|Reinstatement of Enhanced Medicaid Dental Benefits |
The Idaho Legislature has reinstated enhanced Medicaid dental benefits for all Medicaid eligible adults. Regardless of what Medicaid plan the participant is on, all Medicaid eligible adults have access to the Enhanced Medicaid Dental Benefits as of July 1st 2018. Participants on the Basic Plan or the Pregnant Women plan will now have full access to enhanced dental benefits.
Medicaid participants who have questions about their dental benefits can call MCNA’s participants services line @ 855-233-6262 (Monday – Friday, from 6 a.m. to 6 p.m., MST). MCNA providers can call MCNA’s provider services line @ 855-235-6262 (Monday – Friday, from 6 a.m. to 6 p.m., MST)
|July MedicAide Newsletter Now Online|
The July 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.
|Attention Hospital Providers|
In May 2017, Idaho Medicaid implemented once in a lifetime procedure reimbursement for physicians and healthcare professionals. Effective 6/29/2018, this policy will be implemented for inpatient claims using the ICD-10 Procedure Codes. Please refer to the Once in a Lifetime Procedures and Modifiers article in the May 2017 MedicAide newsletter for additional details regarding this policy.
|Attention Pediatric Care Providers |
Postpartum Depression Screening During an EPSDT Well-Child Visit as of January 1, 2018
Idaho Medicaid follows the American Academy of Pediatrics “Bright Futures: Guidelines for Health Supervision of Infants, Children, and Adolescents.” Please see the updated Idaho MMIS Provider Handbook, General Provider and Participant Information, section on Wellness Exams. The recommended maternal depression screening is a benefit for the child and part of the Early & Periodic Screening, Diagnostic & Treatment (EPSDT) visit benefit billed to Molina HealthPas MMIS (not the IBHP plan).
During a Well-Baby visit for an infant, the Department encourages screening of new mothers for postpartum depression. The codes can be submitted with the Well-Baby visit under the infant’s Medicaid ID number.
Use one of the two new codes to indicate the screening results of a positive or negative result:
- G8431 will be used to code for a positive depression screen
- G8510 will be used to code for a negative depression screen
These codes are effective as of January 1, 2018. Medicaid reimbursement $10.28 per screening. The available limit is three (3) screenings per infant under twelve (12) months of age. See the American Academy of Pediatrics Bright Futures Periodicity Table for a recommended schedule.
Please follow the guidelines below when billing G8431 or G8510:
- Bill only when one of the standardized screening instruments is used:
- Edinburgh Postnatal Depression Scale (EPDS)
- Patient Health Questionnaire – 9 (PHQ-9) Screener
- Beck Depression Inventory (BDI)
- Bill using the child’s Idaho Medicaid participant ID number. Claims billed under the mother's Medicaid ID number will be denied.
|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!