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
    
Gainwell Provider Survey

​Gainwell Technologies is excited to invite providers to respond to our Provider Satisfaction Survey starting in February. Our Provider Feedback Team will email providers who have had recent interactions with Gainwell Technologies for Idaho Medicaid. The email will include a short survey, which should take 5 minutes or less to complete, and you can simply return it back to us via email. Provider Satisfaction Survey results will be supplied to the State. Thank you in advance for your valuable time and insight. We are looking forward to hearing from you.

February MedicAide Newsletter Now Online
​​The February edition of the MedicAide Newsletter is now available online. Please click here for the latest news and information affecting Idaho Medicaid providers.
DRG Claims Reprocessing

​An analysis of claims that were submitted between 10/1/2022 and 1/20/2023 showed that roughly 65% of all DRG claims must be reprocessed for accuracy. Providers do not need to do anything. Impacted providers will receive direct email communication from their Provider Relations Consultant over the next several weeks outlining the timeline, impact and expected outcome of our reprocessing efforts. Thank you for the continued service you provide to Idaho Medicaid participants; we look forward to correcting these impacted claims and appreciate your patience. 

Provider Enrollment Application or Maintenance Case with "Needs More Info" Status
If any items need to be corrected on your enrollment or maintenance case, a letter will be generated and emailed to the address on file outlining what actions must be taken in order for the enrollment or maintenance case to be processed and the application will be returned in a “Needs More Info (NMI)” status. All items outlined on the letter must be addressed before you resubmit the case and only the changes requested should be made during this case. 
 
All communications from the Gainwell Provider Enrollment department are sent via email to the email address on file; be sure to check your junk folder in situations when you’re expecting correspondence or a response from the enrollment department.
Provider Request for Alternate Effective Date Form Reminder!
Gainwell Technologies and IDHW worked jointly in 2022 to enhance the alternate effective date process and reduce burdens on the provider community when needing to elect a backdate of up to 365 days prior to the current date during the enrollment process. Any applicable license, certification or other required credential must be valid on or before the requested date.

In extremely unique situations, with supporting documentation, an alternate effective date of more than 365 days prior to the current date may be requested utilizing the current version of the Provider Request for Alternate Effective Date form. A claim and chart notes that reflect the requested alternate effective date are required in addition to the form. When requesting an alternate effective date, Gainwell and IDHW will not review or process the request if the current form is not utilized, or the claim and chart notes are missing. A rejection letter will be delivered via email to the email address associated to the case with additional instruction and information.
Attention Providers Licensed by the State of Idaho Bureau of Facility Standards

​If you are a provider who is licensed by the State of Idaho Bureau of Facility Standards and you’ve completed your renewal with them, Gainwell Technologies will update the license information on the provider record on your behalf and participation in the Idaho Medicaid program will continue.
Gainwell, in collaboration with IDHW, is working to establish a process for these license updates for future years and will communicate with the impacted providers once more information is available.
Thank you for the service and care you offer to our Idaho Medicaid participants.  

2022 1099 Information for Providers

​Any provider who received payments totaling $600 or more for the calendar year of 2022 will receive a 1099 from Idaho Medicaid. All 1099s will be mailed by 1/31/2023 to the W9 address that is on file. Please review the FAQs in the 1099 category for more information related to the 1099. Contact us at 1(866) 686-4272 or contact your Regional Provider Relations Consultant with any unanswered questions you may have. Thank you! 

Attention Home Health and PCS Providers – Claim Processing Timeframe

​All claims that are subject to Electronic Visit Verification (EVV) may pend for up to 10 days, in order to identify a correlating visit that was submitted through your aggregator, however 90% of these claims process within  three days. It’s best practice to submit claims earlier in the week to allow the necessary time for the visit search to be completed. Claims submitted on Thursday will not have enough time to pend, search for the visit and be picked up and included in the financial cycle by Thursday evening. Please note that all claims may pend for up to 30 days for reasons other than EVV, if manual review and intervention is necessary.  

Administrator Update and Gaining Access to the Secure Trading Partner Account (TPA)
The Idaho Medicaid Provider Portal is a secure tool that allows providers full access to claim and eligibility information, direct communication with Gainwell through secure messaging, maintaining the enrollment record, management of the account and much more.

When the Trading Partner Account is set-up, the individual who establishes the account is made the administrator, who then has full access to the account, and is expected to manage security and access for each additional user within their practice. The TPA administrator(s) are also expected and required to be listed on the Ownership information, at a minimum, as a Managing Employee. These individuals are granted full access to all areas of the Trading Partner Account and have security clearance to grant/terminate access to all other users.

We understand that in rare circumstances the account administrator may part ways from the practice, leaving the Trading Partner Account unmanaged or at times, inaccessible. Gainwell understands the need and urgency you may have to gain access to the account again. It is critical for security reasons that we follow strict measures when assisting any user with gaining access to an already established account.
To request this level of support, all of the following criteria must be provided and emailed to idedisupport@gainwelltechnologies.com:
  • A request letter on company letterhead, including the following details, with physical signature and date, signed by an individual who is listed on the ownership form:
    • Reason for update (previous administrator is no longer employed, change in ownership, new manager, etc.)
    • Old admin information (name, username and email address)
    • New admin information (name, username and email address)
    • Pay-to NPI, Trading Partner ID and name that is on record with Gainwell Technologies
  • Only an individual who is listed as an owner, board member or managing employee on the Ownership information is eligible to become the new account administrator and the request itself must be signed by either this individual or another individual on the Ownership information.
    • If you do not know who is listed on the Ownership information for the provider’s record, you may request to update the Ownership details to add the new account administrator by completing this form and including it with your request and email. Once account access is reestablished, the individual must be added to the electronic Ownership information within their application. Note: At least one individual person must be listed on the Ownership document and their DOB and SSN.
Provider Responsibility to Check Eligibility

​Gainwell Technologies has noted a significant increase in the participant community inquiring with us if services are eligible for coverage. Per the General Information and Requirements for Providers, Idaho Medicaid Provider Handbook, section 7.2 Verifying Participant Eligibility providers are required to verify and document participant eligibility and Healthy Connections enrollment status on the date of service prior to rendering services to qualify for reimbursement. Additionally, per IDAPA 16.03.09.210.01.c. providers are required to check a participant’s eligibility for services on the date the service is rendered. Providers are also required to maintain proof that they checked eligibility. Providers may not require participants to check their eligibility for services for them.

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 2023 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. 
Provider Enrollment Application or Maintenance Case with "Needs More Info" Status
​If any items need to be corrected on your enrollment or maintenance case, a letter will be generated and emailed to the address on file outlining what actions must be taken in order for the enrollment or maintenance case to be processed and the application will be returned in a “Needs More Info (NMI)” status. All items outlined on the letter must be addressed before you resubmit the case and only the changes requested should be made during this case. 
 
All communications from the Gainwell Provider Enrollment department are sent via email to the email address on file; be sure to check your junk folder in situations when you’re expecting correspondence or a response from the enrollment department.
Provider Request for Alternate Effective Date Form Reminder!
Gainwell Technologies and IDHW worked jointly in 2022 to enhance the alternate effective date process and reduce burdens on the provider community when needing to elect a backdate of up to 365 days prior to the current date during the enrollment process. Any applicable license, certification or other required credential must be valid on or before the requested date.

In extremely unique situations, with supporting documentation, an alternate effective date of more than 365 days prior to the current date may be requested utilizing the current version of the Provider Request for Alternate Effective Date form. A claim and chart notes that reflect the requested alternate effective date are required in addition to the form. When requesting an alternate effective date, Gainwell and IDHW will not review or process the request if the current form is not utilized, or the claim and chart notes are missing. A rejection letter will be delivered via email to the email address associated to the case with additional instruction and information.
Attention Providers Licensed by the State of Idaho Bureau of Facility Standards
If you are a provider who is licensed by the State of Idaho Bureau of Facility Standards and you’ve completed your renewal with them, Gainwell Technologies will update the license information on the provider record on your behalf and participation in the Idaho Medicaid program will continue.
Gainwell, in collaboration with IDHW, is working to establish a process for these license updates for future years and will communicate with the impacted providers once more information is available.
Thank you for the service and care you offer to our Idaho Medicaid participants.  
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.