Online Help Help

  • Idaho Medicaid Program
    Health Coverage
    for Idaho families
  • Idaho Medicaid Program
    Health Coverage
    for Idaho families
  • Idaho Medicaid Program
    Health Coverage
    for Idaho families
    
Attention: Acute Care HospitalsNew

​Effective July 1, 2022, acute care hospitals will be required to bill a procedure code on each outpatient hospital claim line submitted.  This will provide the Department and hospitals the necessary detail to make data-driven decisions for the hospital outpatient prospective payment system called APCs (Ambulatory Payment Classifications). The APC payment system effective date is scheduled for July 1, 2024. This change does not affect Critical Access hospitals, State-owned hospitals, and Institutions for Mental Disease.  

Healthy Connections Rosters

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

Claim Review Request Instructions and Form

Gainwell Technologies, in collaboration with the Idaho Department of Health and Welfare, has revised the Claim Review Request (CRR) instructions and form. The updated and improved instructions and form can be found by hovering over the Reference Material tab and selecting Gainwell Technologies Forms or by following this link.

A Claim Review Request can be used for many reasons, but should not be used in some instances. Here are a few examples*:

CRR is used:CRR is not used:
If you disagree with the denial or payment of a claim and would like it manually reviewedTo adjust a claim and attach documentation (for example: EOB, invoice, sterilization/hysterectomy consent forms, NOA for timely filing, run/trip report)
If the claim has denied for a bundling issue against another denied claim/service lineFor Share of Cost (SOC) issues
If the claim has denied for duplicate claim issues inappropriately To request additional information on a Health Management Systems (HMS) adjustment/recoupment
If a service was denied for a lifetime benefit exceeded inappropriately To request a recoupment when the claim is within the 2-year adjustment period
To adjust a claim after a participant's eligibility has been updated

*Note: This is not an all-encompassing list

All Claim Review Request forms must be mailed to Gainwell Technologies and the current form must be completed. Any CRR forms that are received via fax or email will not be processed into the system. If the form is incomplete it will be rejected and returned to the provider.

In the case where you may have more than five Claim Review Requests to send to Gainwell for reconsideration, you're encouraged to engage with your Provider Relations Consultant first; they can assist you with the denial and ensure using the CRR process is the most efficient way for your claim issues to be addressed.

When attaching documentation to the request do not attach the patient's entire medical record. For safety and efficiency in processing we ask that you only attach documents that are pertinent to the claim under review.

As of April 1, 2022 the updated form is expected to be used by providers and any Claim Review Request that is received on or after May 1, 2022 on the outdated form(s) will be returned to the provider.

Thank you for your cooperation and understanding for this necessary change! 

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 Gainwell Technologies 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. 

 COVID-19

Official Resource for Novel Coronavirus(COVID-19) :
https://coronavirus.idaho.gov/resources-for-healthcare-providers
Information Releases :
/Lists/Information%20Releases/AllItems.aspx

 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 2022 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. 

 Gainwell Technologies Partners

Click here for a list of contact information for our valued partners. 
Enhancement to the Idaho Medicaid Alternate Effective Date ProcessNew
Gainwell Technologies in collaboration with the Idaho Department of Health and Welfare implemented an enhancement to the Alternate Effective Date Process. Feedback was received from our provider community and this enhancement was made with the intent to reduce burdens within this much-needed and utilized process.

Providers are now able to elect an effective date up to 365 days prior to the current date during the enrollment or maintenance process for newly affiliated rendering providers, service locations or the pay-to service location. After entering the date in the Provider Enrollment Application system a confirmation pop-up message will display confirming a date from the past was entered. As previously required, the rendering provider or new location must be covered by an applicable license, certification or other required credential for approval.

Additionally, with this enhancement we added the ability to future date a rendering provider affiliation or a new service location up to 60 days from the current date.

On the Documents tab the required Alternate Effective Date form is no longer needed for any new rendering provider or service location. Until this final system configuration piece is moved into our production system, please mark Mail-In from the drop-down when this form populates to bypass.

In rare circumstances an effective date that is greater than 365 days prior to the current date may be necessary. Approval may be granted if the criteria is met. A claim and chart notes that reflect the requested alternate effective date is required, along with any applicable license, certification, or other required credentials. To request a copy of the Alternate Effective Date form for this situation, please email idproviderenrollment@gainwelltechnologies.com. 
Attention! Behavioral Health Providers

​If you are a provider who is enrolling or enrolled as a Mental Health Clinic, Rehabilitative Mental Health Service provider, Mental Health Case Management provider or any other provider that renders behavioral health services, you may also be required to enroll and maintain your provider record with Optum Idaho. For more information, contact Optum. Regional Network Managers can assist you and are listed on the Regional Representation Flyer found at www.OptumIdaho.com > Contact Us tab. 

 Idaho Medicaid Member Resources

​Participant Services Phone ​1 (866) 686-4752 (Toll-free), 1 (208) 373-1432 (Local)
​Participant Services E-mail idparticipantservices@gainwelltechnologies.com
​Participant Information Website https://healthandwelfare.idaho.gov/services-programs/medicaid-health
​Language Services http://healthandwelfare.idaho.gov/AboutUs/LanguageAssistance/tabid/3766/Default.aspx
​Idaho Health Plan Coverage Booklet - English https://publicdocuments.dhw.idaho.gov/WebLink/DocView.aspx?id=2080&dbid=0&repo=PUBLIC-DOCUMENTS
​Idaho Health Plan Coverage Booklet - Spanish https://publicdocuments.dhw.idaho.gov/WebLink/DocView.aspx?id=2081&dbid=0&repo=PUBLIC-DOCUMENTS

 Gainwell Technologies Contacts

Gainwell Provider Relations Consultants Contact Information
Idaho Medicaid Contact Information (Provider Services, Provider Enrollment, and Gainwell partners)

 

 Resources & Links

 

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@gainwelltechnologies.com.