| | 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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| | Best Practices for the Trading Partner Account | | Gainwell is proud to share the following with the provider community relating to the Trading Partner Account (TPA), the risks and best practices for the tool. What is a Trading Partner Account? This is the system that grants secure access for providers to manage their Idaho Medicaid record. This includes: - Management of additional TPA users
- Management of Billing Agents
- Account Information
- EDI Certification
- Enrollment and Maintenance
- X12 Transactions
- Reports(Remittance, Claims in Process, Healthy Connections Rosters)
- Authorizations
- View status details, submit and adjust claims
- Participant eligibility verification
- Patient/PCP Rosters
- Finance/Payment Details
- View and submit referrals
- View and submit LTC cases, as necessary
When enrolling with Idaho Medicaid providers are required to: - Register a Trading Partner Account
- Identify and maintain an internal administrator for their account, who should be listed on their Ownership information
- Update and maintain their account users and security clearance
- Terminate internal users who are no longer affiliated with their organization in a timely manner, to safeguard their information and the information of the Idaho Medicaid participant community.
- The person who registers the TPA is the first account administrator and can do the following:
- Manage users
- Add additional administrators
- Access and update provider associations
- Manage TPA information (i.e., demographic edits)
Risk to consider: - Attrition impacts most employers
- Timely termination of access removes the potential temptation and risk of unwarranted vulnerabilities, this includes the risk to your organization and the Idaho Medicaid participant information.
- It is TPA Account users' responsibility to educate their staff to understand the system, access, and security clearance, to partner to mitigate risk and protect the information within our accounts.
- It is each of our responsibilities to take an active role in safeguarding the information at our fingertips. As technology advances so will the efforts and abilities of those who mean to defeat our security protocol. We must stay ever vigilant in our protection efforts.
Best Practice Tips: - Early and frequent discussions within your organization
- Do you have the right person set up as the administrator?
- Do you have a back-up plan if our chosen administrator is unable to perform duties within the TPA, such as another user with rights to terminate and add new users if needed
- Who is granting access to users?
- Are they reviewing and updating the user list frequently to accommodate new hires, terminations, and changes in access?
- Does the designated administrator have a clear understanding of the security clearance they are granting to users?
- Safeguarding access to allow only “what is needed based on role” minimizes accidental and intentional modifications to things such as EFT, banking, provider demographic and contact information, as well as creation of unauthorized users.
- Who can change bank account information? This is R1 and we suggest that this be limited to one or two individuals.
- Billing Agents and other entities should not own your Trading Partner Account.
- Gainwell strongly encourages providers to register and maintain their own TPA.
- Access by invitation may be given and removed as needed by the provider within the system functionality.
- We have seen many occasions where providers have allowed the billing agent to set up their TPA and then later the relationship is termed, and the provider essentially loses access to their TPA historical information when an account needs to be termed and new one registered.
Please visit our Best Practices for Trading Partner Account Administrators sheet today for more information. If you have any questions, please engage with your Provider Relations Consultant. |
| | Best Practices for Ownership Information | | Gainwell is proud to share the following with the provider community relating to the importance of the Ownership information and how it’s leveraged to protect your provider record. When enrolling with Idaho Medicaid providers are required to: - Submit an initial comprehensive report of their Ownership information, which includes Managing Employees
- Maintain and update the Ownership records through maintenance of their provider record following their enrollment.
Risk to consider: - Attrition impacts most employers
- Timely termination of access removes the potential temptation and risk of unwarranted vulnerabilities, this includes the risk to your organization and the Idaho Medicaid participant information.
- As technology advances so will the efforts and abilities of those who mean to defeat our security protocols. We must stay ever vigilant in our protection efforts. It is each of our responsibilities to take an active role in safeguarding the information at our fingertips.
How ownership is leveraged to validate change request: - To confirm and validate update requests, we may require multiple confirmations of the change before approving, such as a secure message and verbal communication about the change.
- A few examples:
- Changes to the payment method; changing Electronic Funds Transfer information or dropping the payment method to paper checks
- Changes to Trading Partner Account information or access
Best Practice Tips: - Review and update your Ownership record frequently
- Ensure your Ownership list includes managing employees that have the authority to approve these types of changes to your provider record
- Ensure that you have listed contacts that are available to confirm these change requests by phone and electronically via your secure messaging Trading Partner Account
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| | Attention Idaho Medicaid Providers Using Secure Messaging | | Our Gainwell Technologies representatives are eager to resolve your secure message inquiries in a timely and informative manner. To save you time and energy we would like to ask for your support in eliminating unnecessary interactions when working to resolve issues for claims, eligibility, or EDI inquiries.
Here is how you can help:
- Review the responses that are returned and in your Inbox from your Secure Message. Messages will appear in near-real time from the time our team has responded. All messages are responded to in one to two business days.
- 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.
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 become as healthy and self-sufficient as possible. |
| | 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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