MedicAide September 2018 Page 1 of 16
In This Issue
Information Releases ................................................................................................................ 1 Code Updates .......................................................................................................................... 2 CPT© 80050: General Health Panel ............................................................................................... 2 Billing for Breast Pumps ............................................................................................................ 2 Reminder: Family Planning Services Require the FP Modifier .......................................................... 3 Reminder to Medical, Surgical and Therapy Providers: Referrals Are Not Orders ............................... 3 Physician and Non-Physician Practitioner Contractors ................................................................... 3 Timely Filing of Claims with Third Party Insurance ........................................................................ 3 YES Project Update for Healthy Connections and the September MedicAide Issue ............................. 4 Idaho Medicaid Plus, Twin Falls County ....................................................................................... 5 Provider Handbook Updates ...................................................................................................... 5 Attention: DMEPOS Suppliers .................................................................................................... 7 Notice of Rulemaking – Proposed Rule For Organ Transplants ........................................................ 8 Medicaid Program Integrity ......................................................................................................10 Provider Training Opportunities in 2018 .....................................................................................11 Medical Care Unit Contact and Prior Authorization Information ......................................................12 DHW Resource and Contact Information ....................................................................................13 Insurance Verification ..............................................................................................................13 Molina Provider and Participant Services Contact Information .......................................................14 Molina Provider Services Fax Numbers .......................................................................................14 Provider Relations Consultant (PRC) Information .........................................................................15
Information Releases No table of figures entries found.
An Informational Newsletter for Idaho Medicaid Providers
From the Idaho Department of Health and Welfare, September 2018
Division of Medicaid
MedicAide September 2018 Page 2 of 16
Code Updates
Codes being added that will be reimbursable:
Code Description Effective
Date
90750 Zoster (shingles) vaccine (HZV), recombinant, subunit, adjuvanted, for intramuscular use 8/1/2018
C9030 Injection, copanlisib, 1 mg 7/1/2018
C9032 Injection, voretigene neparvovec-rzyl, 1 billion vector genome 7/1/2018
Codes that are no longer covered:
Code Description Effective
Date
80050 General Health panel 2/1/2018
Per the Idaho Medicaid DMEPOS PA Policy and Medical Criteria Codes only for
participants on a waiver:
Code Description Effective
Date
E0241 Bath tub wall rail each 7/1/2018
E0242 Bath tub rail floor base 7/1/2018
E0243 Toilet rail each 7/1/2018
E0244 Toilet seat raised 7/1/2018
E0245 Tub stool or bench 7/1/2018
E0246 Transfer tub rail attachment 7/1/2018
E0247 Transfer bench tub/toilet w/wo commode open 7/1/2018
E0248 Heavy duty transfer bench w/wo commode open 7/1/2018
E0705 Transfer device, each 7/1/2018
CPT© 80050: General Health Panel
CPT© 80050 (General Health Panel) has been determined by Medicare to not be reasonable and
necessary. Idaho Medicaid has followed this determination by making the code non-covered.
Providers may still bill individual tests with medical necessity obtained for each. As a reminder,
screenings aren’t covered unless the United States Preventive Services Task Force has given an A
or B recommendation, or the screening is in the Bright Futures guidelines for pediatrics.
Billing for Breast Pumps
Effective 10/01/2018, manual and automatic breast pumps (E0602 and E0603) are only available
as a purchase under the mother’s Medicaid Identification Number (MID).
Hospital grade heavy duty electric breast pump (E0604) is available only when provided as a
rental and must have a prior authorization. It may be billed under the infant’s MID if the mother
no longer has Medicaid.
MedicAide September 2018 Page 3 of 16
Reminder: Family Planning Services Require the FP Modifier
Family planning services (services that delay or prevent pregnancy), devices and prescriptions
must be billed with the FP modifier, and an NDC if applicable. The FP modifier allows the State of
Idaho to provide services through an enhanced federal match that pays 90% of the state’s costs.
While this modifier does not affect a provider’s reimbursement directly, it could lead to a civil
monetary penalty from the Medicaid Program Integrity Unit if not used appropriately.
Claims with multiple services should have the FP modifier only on lines for the family planning
service. Evaluation and management services that spent more than half their time for family
planning services should include the FP modifier as well.
Please, see the Physician and Non-Physician Practitioner section of the Idaho Medicaid Provider
Handbook for more information, and this article from CMS, https://www.medicaid.gov/federal-
policy-guidance/downloads/sho16008.pdf.
Reminder to Medical, Surgical and Therapy Providers: Referrals Are Not Orders
As a reminder to all providers, referrals may not be accepted in lieu of a physician or non-
physician practitioner’s order for services or items.
A referral is a documented communication from a participant’s primary care provider (PCP) to
another Medicaid provider for their patient to see them for a condition. The referral allows the
PCP to coordinate the participant’s care for services that are outside of the PCP’s expertise, but
does not tell the other provider how to provide treatment. An order, however, is an instruction
that specifies the test, drug, item or service to provide to the participant, how long it should last
and how often it should be done.
See the General Provider and Participant Information, Idaho Medicaid Provider Handbook for
additional information on the Healthy Connections program, and referrals.
Physician and Non-Physician Practitioner Contractors
Physician and Non-Physician Practitioner contractors providing a Medicaid reimbursable service
within their scope of practice and licensure must bill Idaho Medicaid directly under their own NPI.
For example if an office contracts a physician to read their x-rays, the physician must be enrolled
with Idaho Medicaid and bill the interpretation directly to the Medicaid program. The only
exception is defined in the Physician and Non-Physician Practitioner, Idaho Medicaid Provider
Handbook, for Locum Tenens Arrangements and Reciprocal Billing Arrangements.
Timely Filing of Claims with Third Party Insurance
Providers are reminded that if a participant has third party insurance other than Medicare, a
claim must be submitted to Idaho Medicaid within 365 days of the date of service regardless of
whether the other insurance has processed, paid or denied the claim. Claims denied by third
party carriers for timely filing will also be denied by Idaho Medicaid. Please refer to the Idaho
MedicAide September 2018 Page 4 of 16
Medicaid Provider Handbook, General Billing Instructions, for more information regarding timely
filing requirements.
YES Project Update for Healthy Connections and the September MedicAide Issue
As a result of the Jeff D. lawsuit, the Youth Empowerment Services (YES) project was developed
and tasked with transforming children’s mental health in Idaho by creating the YES System of
Care. The YES System of Care includes mental health services provided to children through the
Division of Medicaid, the Division of Behavioral Health, the Division of Family and Community
Services, the State Department of Education, and the Idaho Department of Juvenile Corrections.
On January 1st, as part of this project, Medicaid launched the Medicaid Serious Emotional
Disturbance (SED) program to create a new eligibility group and authorize respite services for
children with SED.
Other important milestones launched in relation to this project include:
• Contracting with Liberty Healthcare as the Independent Assessment Provider (IAP) to
assess children for SED by conducting a Comprehensive Diagnostic Assessment and using
the Child and Adolescent Needs and Strengths (CANS) tool;
• The development of a Person-Centered Service Planning process for children with SED
and children with both SED and developmental disabilities (DD). These are facilitated by
the Division of Behavioral Health (DBH) and the Division of Family and Community
Services’ (FACS);
• The implementation of new practice standards for Medicaid behavioral health services
provided to children;
• The launch of new behavioral health services in addition to respite, offered through the
Idaho Behavioral Health Plan (IBHP) administered by Optum Idaho;
• New services that will be billable by primary care physicians. More information regarding
these services will be provided this fall.
How to Refer Families for Services
If you know a child who may need mental or behavioral health services and is already Medicaid
eligible, please have them contact Optum Idaho at 1-855-202-0973 to find a behavioral health
provider in their area. If they are already Medicaid eligible and their family would like access to
the new respite services, please have them contact Liberty Healthcare at 1-877-305-3469 for an
assessment to determine if they qualify as having SED and therefore qualify to access respite.
If they are not already Medicaid eligible, please have them contact Liberty Healthcare at 1-877-
305-3469 for an assessment to determine if they qualify as having SED. If the child is found to
have SED, the family may then apply for Medicaid with the expanded eligibility income limits (up
to 300% FPL). After applying for Medicaid, if the child is found eligible, they may contact Optum
Idaho at 1-855-202-0973 to begin accessing services. If they are not found Medicaid eligible,
they may contact the Division of Behavioral Health to access non-Medicaid mental health services
at 1-855-643-7233 or [email protected].
For more information regarding the YES System of Care and the YES Principles of Care and
Practice Model, please visit: http://youthempowermentservices.idaho.gov.
For more information on new behavioral health services provided through the Idaho Behavioral
Health Plan, please visit: https://www.optumidaho.com.
MedicAide September 2018 Page 5 of 16
For questions regarding the Medicaid SED Program, please email: [email protected].
Idaho Medicaid Plus, Twin Falls County
Idaho Medicaid will be implementing a mandatory managed care program, called Idaho Medicaid
Plus (IMPlus), in Twin Falls County on November 1, 2018. This program is for individuals who are
eligible and enrolled in Medicare Parts A, B, and D, in addition to Enhanced Medicaid coverage
and who have not enrolled in the Medicare Medicaid Coordinated Plan (MMCP).
Enrollment letters were mailed to affected Dual Eligible Beneficiaries in Twin Falls County on July
1, 2018, informing them of the upcoming changes and requesting that they notify Idaho Medicaid
of their selection of a health plan to administer their Medicaid benefits. The following link:
IMPlus Enrollment Forms will take you to the letter and form participants received to inform them
of the new mandatory program and how to choose a plan to manage their Medicaid benefits.
Participants will receive a new insurance identification card from the health plan they have
selected or been assigned to during the month of September. Examples of the ID cards can be
found at Sample IMPlus ID Cards. All providers servicing Medicaid participants in Twin Falls
County are encouraged to contract with both Blue Cross of Idaho and Molina Healthcare of Idaho
to ensure prompt payment of all claims for Dual Eligible beneficiary claims. For additional
information, please go to www.mmcp.dhw.idaho.gov.
Provider Handbook Updates
The Agency Professional handbook was updated to:
• Provide reference to general handbooks.
Remove references to Infant Toddler Program (ITP).
• Provide direction the Idaho Medicaid Fee Schedule for covered codes.
• Clarify the requirement for the FP modifier on family planning services.
• Move code lists from CMS-1500 to appropriate sections of the handbook.
The Ambulatory Health Care Facility handbook experienced significant changes to consolidate
information, clarify coverage and reimbursement.
The Chiropractor handbook was updated to:
• Include services under an encounter rate when provided in an FQHC, IHS and RHC.
Provide reference to general handbooks.
Provide information on checking eligibility.
The CMS-1500 Instructions handbook was updated to:
• Move instructions for Agency – Professional billing to the handbook of the same name.
• Move instructions for Ambulatory Health Care Facility billing to the handbook of the
same name.
• Move instructions for Preventive Health Assistance (PHA) billing to the General Provider
and Participant handbook.
• Move instructions for Supplier billing to the handbook of the same name.
The General Billing Instructions handbook was updated to add:
• Clarification on what services are exempt from a co-pay.
MedicAide September 2018 Page 6 of 16
The General Provider and Participant handbook was updated to add:
• New section, Medical Necessity.
Clarifications for Non-Coveredand Excluded Services section.
Clarification that documentation of services should be signed by rendering provider.
• Clarification that psychiatric nurse practitioners can provide psychiatric crisis
consultation through telehealth.
• Reminder that a referral is not a physician’s order.
• A table of codes for non-physician weight management under the Preventive Health
Assistance (PHA) program.
New section, Provider Agreement Example.
The Glossary was updated to:
• Add Distant site, forensic exam, forensic interview, life threatening, medically necessary,
office of mental health and substance abuse, “ordering, referring or prescribing provider”,
originating site, participant, subluxation, synchronous interaction and telehealth.
Update definitions for ARC, Buy-In, CPT©, EFT, Individual, NEMT, Policy, POS, and UB-
04.
Remove definitions not used in provider handbook.
The Hospital handbook was updated to add:
• Clarification that associated items and services for non-covered transplants are also not
covered.
• Clarification that the physician should provide necessary documentation for claims
related to abortion.
The Overview was updated to remove:
• ICD-9 and ICD-10 Diagnosis Billing Requirements.
• Physician Assistants & Advanced Practice Nursing, and replace with Physician and Non-
Physician Practitioner.
• Interpretive Services Policy.
• Telehealth Policy.
• Vision Chronic or Acute Condition Diagnosis Codes.
• Allopathic and Osteopathic Physicians, and replace with Physician and Non-Physician
Practitioner.
The Physician and Non-Physician Practitioner handbook was updated to:
• Return nurse midwife as an affected provider type after being previously omitted in
error.
Provide reference to general handbooks.
Provide information on checking eligibility.
Include information on wellness exams for the DD program and refugees.
• Include the copay exemption for children’s wellness exams.
• Add a new section on dilation and curettage.
• Add 99358 and 99359 to the section on Prolonged Services.
Add new section on lactation counseling.
• Move the anesthesia base units into Appendix B of this handbook.
• Add requirements for participants that received a hysterectomy and were later found to
be retroactively eligible for Medicaid.
• Include services under an encounter rate when provided in an FQHC, IHS and RHC.
• Add information about the required FP modifier for family planning services, and their
exemption from co-pays.
The Podiatric Medicine and Surgery Services handbook was updated to:
MedicAide September 2018 Page 7 of 16
•Provide reference to general handbooks.
Provide information on checking eligibility.
Include services under an encounter rate when provided in an FQHC, IHS and RHC.
• Direct to the Supplier handbook for coverage of orthotics.
Conform with formatting.
The Speech, Language, and Hearing Service Providers handbook was updated to:
• Include information from CMS-1500 handbook.
The Supplier handbook experienced significant changes to consolidate information, clarify
coverage and reimbursement.
The UB-04 Instructions handbook was updated to:
• Remove reference to ICD-9.
Attention: DMEPOS Suppliers
Clarification on Prior Authorization (PA) requirements for Therapeutic & Non- Therapeutic Continuous Glucose Monitors (CGM)
On January 12, 2017, the Centers for Medicare & Medicaid Services (CMS) issued a Ruling (CMS-
1682-R), concluding that certain CGMs, those considered therapeutic CGMs, are covered as a
DME benefit.
To facilitate implementation of this Ruling, the following two codes were added to the HCPCS
code set effective July 1, 2017:
1. K0553 Supply allowance for therapeutic continuous glucose monitor (CGM), includes all
supplies and accessories, 1 unit of service = 1 month's supply
2. K0554 Receiver (Monitor), dedicated, for use with therapeutic continuous glucose monitor
system.
CGM’s are classified as either therapeutic or non-therapeutic. Each classification has different
coding and PA requirements.
Therapeutic CGM
• PA requests that are classified by Medicare as therapeutic CGM devices must be
requested with K0554 for the therapeutic CGM receiver and K0553 for the supply
allowance. Only one (1) month of the supply allowance (one (1) Unit of Service) may be
billed at a time.
Non-therapeutic CGM
• PA requests for devices classified by Medicare as non-therapeutic CGM devices and
related supplies must be submitted using codes A9276, A9277 and A9278.
Idaho Medicaid has rules and requirements following our DMEPOS program. We follow
CMS/Medicare regulations and guidance to align with national standards and best practice for
billing and coding.
Only the G5 model is approved for Medicare, Idaho Medicaid does elect to cover DeXcom G5
series at this time and the FreeStyle Libre Flash. These models must have the K codes submitted
on PA requests. All other models may be submitted with A codes.
Questions have arisen about the proper codes for PA submission for CGM’s and their related
supply allowance. The following instructions apply to all PA request for CGM and related supplies:
MedicAide September 2018 Page 8 of 16
• Only the G5 model is approved for Medicare however Idaho Medicaid does elect to cover
both G5 & G6. The supplies and the receiver for these systems must have K codes
requested on PA submission.
• The FreeStyle Libre Flash is also covered in accordance with FDA’s clinical guidelines.
The supplies and the receiver for these systems must have K codes requested for PA
submission.
• All other models of CGM models may be submitted with A codes.
PA submissions need to include; model being requested along with corresponding HCPC codes,
physician order and supporting documentation. Further information is available by reviewing the
Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Prior Authorization
(PA) Policy and Medical Criteria Handbook located at:
https://healthandwelfare.idaho.gov/Portals/0/Medical/MedicaidCHIP/DMEPOS.pdf
Notice of Rulemaking – Proposed Rule For Organ Transplants
PUBLIC HEARING SCHEDULE: A public hearing concerning this rulemaking will be held as
follows:
Department of Health & Welfare Medicaid Central Office
3232 Elder Street Conference Room D-West
Boise, ID 83705
Toll Free: 1-877-820-7831
Participant Code: 701700
The hearing site(s) will be accessible to persons with disabilities. Requests for accommodation
must be made not later than five (5) days prior to the hearing, to the agency address below.
DESCRIPTIVE SUMMARY: The following is a nontechnical explanation of the substance and
purpose of the proposed rulemaking
Currently, IDAPA 16.03.10, “Medicaid Enhanced Plan Benefits” specifies a list of covered organ
transplants. As medical science has advanced, the procedures accepted as standard treatment
have surpassed what rule allows. Section 56-255, Idaho Code, requires Medicaid to cover
medically necessary services, and coverage has been approved under the allowance in IDAPA
16.03.09, “Medicaid Basic Plan Benefits” for coverage of investigational services for life-
threatening medical conditions without other treatment options, or through Early, Periodic,
Screening, Diagnostic and Treatment (EPSDT) services for children under 21. This rulemaking
aligns these rules with statute.
FISCAL IMPACT: The fiscal impact of expanding lung organ transplants to include participants
over the age of 21, and covering liver transplants from live donors would be cost neutral as
current requests are paid under investigational services.
PUBLIC HEARING
TELECONFERENCE CALL-IN
Monday, September 24, 2018 - 10:00 a.m.
MTa.m. (MDT)
MedicAide September 2018 Page 9 of 16
NEGOTIATED RULEMAKING: Pursuant to Section 67-5220(1), Idaho Code, negotiated
rulemaking was conducted. The Notice of Intent to Promulgate Rules - Negotiated Rulemaking
was published in the June 6, 2018, Idaho Administrative Bulletin, Volume 18-6, pages 61 and 62.
ASSISTANCE ON TECHNICAL QUESTIONS, SUBMISSION OF WRITTEN COMMENTS: For assistance
on technical questions concerning the proposed rule, contact William Deseron at (208) 287-1179.
Anyone may submit written comments regarding the proposed rulemaking. All written comments
must be directed to the undersigned and must be delivered on or before Wednesday, September
26, 2018.
THE FOLLOWING IS THE PROPOSED TEXT OF DOCKET NO. 16-0310-1804 (Only Those Sections With Amendments Are Shown.)
ORGAN TRANSPLANTS.
The Department maywill reimburse for organ transplant services for bone marrows, kidneys,
hearts, intestines, and livers as detailed in the Idaho Medicaid Provider Handbook, when
medically necessary and provided by hospitals approved by the Centers for Medicare and
Medicaid for the Medicare program that have completed a provider agreement with the
Department. The Department may reimburse for cornea transplants for conditions where such
transplants have demonstrated efficacy. (3-19-07)( )
-- 092. (RESERVED)
ORGAN TRANSPLANTS: COVERAGE AND LIMITATIONS.
Kidney Transplants. Kidney transplant surgery will be covered only in a renal transplantation
facility participating in the Medicare program after meeting the criteria specified in 42 CFR 405
Subpart U. Facilities performing kidney transplants must belong to one (1) of the End Stage
Renal Dialysis (ESRD) network area's organizations designated by the Secretary of Health and
Human Services for Medicare certification. (3-19-07)
Coverage Limitations. No organ transplant will be covered by the Medical Assistance Program
unless prior authorized by the Department, or its designee. Coverage is limited to organ
transplants performed for the treatment of medical conditions in accordance with evidence-based
standards of care. ( )
Living Kidney Donor Costs. The transplant costs for actual or potential living kidney donors are
fully covered by Medicaid and include all reasonable medically necessary preparatory, operation,
and post-operation recovery expenses associated with the donation. Payments for post-operation
expenses of a donor will be limited to the period of actual recovery. (3-19-07)( )
Intestinal Transplants. Intestinal transplant surgery will be covered only for patients with
irreversible intestinal failure, and who have failed total parenteral nutrition. (3-19-07)
Coverage Limitations. (3-19-07)
Multi-organ transplants may be covered when: (3-19-07)
The primary organ defect caused damage to a second organ and transplant of the primary organ
will eliminate the disease process; and (3-19-07)
The damage to the second organ will compromise the outcome of the transplant of the primary
organ.
(3-19-07)
Each kidney or lung is considered a single organ for transplant;. (3-19-07)
Re-transplants will be covered only if the original transplant was performed for a covered
condition and if the re-transplant is performed in a Medicare/Medicaid approved facility;.(3-19-07)
A liver transplant from a live donor will not be covered by the Medical Assistance Program;
MedicAide September 2018 Page 10 of 16
(3-19-07)
No organ transplants covered by the Medical Assistance Program unless prior authorized by the
Department, and performed for the treatment of medical conditions where such transplants have
a demonstrated efficacy.
(3-19-07)
Follow-Up Care. Follow-up care to a participant who received a covered organ transplant may be
provided by a Medicare/Medicaid participating hospital not approved for organ transplantation.
(3-19-07)
-- 095.(RESERVED)
ORGAN TRANSPLANTS: PROVIDER REIMBURSEMENT.
Organ transplant, and procurement services, and follow-up care by facilities approved for
kidneys, bone marrow, liver, or heart will be reimbursed the lesser of ninety-six and a half
percent (96.5%) of reasonable costs under Medicare payment principles or customary charges as
specified in the provider agreement. Follow-up care provided to an organ transplant patient by a
provider not approved for organ transplants will be reimbursed at the provider’s normal
reimbursement rates. Reimbursement to Independent for Oorgan Pprocurement Agencies and
Independent Hhistocompatibility Llaboratoriesy tests will not be covered made to the facility
performing the transplant.
(3-19-07)( )
-- 099.(RESERVED)
Medicaid Program Integrity
Correct Billing Using Date Spanning
The Medicaid Program Integrity Unit continues to identify providers who are incorrectly billing
services by date spanning. Providers are reminded when billing with a date span, services must
have been provided consecutively on every day within that span. This information has been
provided in the August 2013, May 2015, and August 2016 MedicAide newsletters.
Section 2.5.5 of the March 2016 Idaho MMIS Provider Handbook, General Billing Instructions,
describes the correct billing procedure for date spanning and states:
For CMS 1500 Claims, non-consecutive dates should not be spanned on a single claim
detail. Providers risk claim denials due to duplicate logic, overlapping dates, and/or
mutually exclusive edits.
When date spanning, services must have been provided for every day within that span.
For example, it would be incorrect to date span the entire week or month when services
were only performed on Thursday and Saturday within the same week or January 1 and
January 10 within the same month
Example:
For services provided to the participant on the following days:
Thursday, December 11, 2008
Saturday, December 13, 2008
...enter each date on a separate detail line.
Providers are responsible to ensure services are billed in accordance with the instructions outlined
above. The Medicaid Program Integrity Unit will be assessing civil monetary penalties for
services that are incorrectly billed with a date span.
MedicAide September 2018 Page 11 of 16
Provider Training Opportunities in 2018
You are invited to attend the following webinars offered by Molina Medicaid Solutions Regional
Provider Relations Consultants.
September: Coordination of Benefits
The Coordination of Benefits training will review COB pricing calculations, entering COB in your
Trading Partner Account, and attaching EOBs.
Training is delivered at the times shown in the table below. Each session is open to any region
but space is limited to 25 participants per session, so please choose the session that works best
with your schedule. To register for training, or to learn how to register, visit
www.idmedicaid.com.
September October November
Coordination of Benefits
Claims Adjust Home Health
Hospice
10:00 - 11:00 AM MT
9/18/2018 10/16/2018 11/15/2018
9/19/2018 10/17/2018 11/19/2018
9/20/2018 10/18/2018 11/21/2018
2:00 - 3:00 PM MT
9/12/2018 10/10/2018 11/8/2018
9/13/2018 10/11/2018 11/14/2018
9/18/2018 10/16/2018 11/15/2018
9/20/2018 10/18/2018 11/19/2018
If you would prefer one-on-one training in your office with your Regional Provider Relations
Consultant, please feel free to contact them directly. Provider Relations Consultant contact
information can be found on page 15 of this newsletter.
MedicAide September 2018 Page 12 of 16
Medical Care Unit Contact and Prior Authorization Information
Prior Authorizations, Forms, and References
To learn about prior authorization (PA) requirements, QIO review, or print request forms, go to
the medical service area webpage at www.medunit.dhw.idaho.gov. Prior authorization request
forms containing the “fax to” number can be found at www.idmedicaid.com. Click on Forms
under the References section and you will see the PA request forms under the DHW Forms
heading. If you prefer to mail in your form, the mailing address is:
Medicaid Medical Care Unit
P.O. Box 83720
Boise, ID 83720-0009
Note: The Medical Care Unit (MCU) does not give authorizations for services over the telephone
or for services which do not require a prior authorization.
To Check Prior Authorizations Status
Log on to your Trading Partner Account on www.idmedicaid.com. Choose Form Entry, then
choose View Authorizations. If you are unable to identify the reason for a denied service, a
Molina Medicaid Solutions representative can provide the medical reviewer’s reason captured in
the participant’s non-clinical notes. If you are unable to view the authorization status, please
review the Trading Partner Account (TPA) User Guide located under User Guides on
www.idmedicaid.com. To speak to a Molina Medicaid Solutions representative, call 1 (866) 686-
4272, option 3.
MCU Medical Review Decisions
If you have any questions about medical review decisions, please refer to the following contact
numbers or e-mail [email protected].
For DMEPOS PA policy, please see the DMEPOS PA Policy and Medical Criteria under the
Resources tab on the DME page. Please review the DMEPOS PA Policy and Medical Criteria to
obtain important information, policy, and guidance relating to requesting PAs for DMEPOS items.
This document also includes the medical criteria used by the Department in most circumstances
related to DMEPOS requests.
Fax Number Phone Number
Administratively Necessary Days 1 (877) 314-8779 1 (866) 205-7403
Ambulance* 1 (877) 314-8781 1 (800) 362-7648
Breast & Cervical Cancer 1 (877) 314-8779 1 (208) 364-1826
Durable Medical Equipment 1 (877) 314-8782 1 (866) 205-7403
Hospice 1 (877) 314-8779 1 (866) 205-7403
Preventive Health Assistance 1 (877) 845-3956 1 (208) 364-1843
Service Coordination 1 (877) 314-8779 1 (866) 205-7403
Surgery-Procedure-Lab 1 (877) 314-8779 1 (866) 205-7403
Therapy: OT, PT, SLP 1 (877) 314-8779 1 (866) 205-7403
Vision 1 (877) 314-8779 1 (866) 205-7403
*Idaho Medicaid contracts with Medical Transportation Management (MTM) for all non-emergency
medical transportation services. Please go to http://www.mtm-inc.net/idaho/ or call 1 (877) 503-
1261 for more information.
MedicAide September 2018 Page 13 of 16
DHW Resource and Contact Information
DHW Website www.healthandwelfare.idaho.gov
Idaho CareLine 2-1-1
1 (800) 926-2588
Medicaid Program Integrity Unit P.O. Box 83720
Boise, ID 83720-0036
[email protected]
Fax: 1 (208) 334-2026
Telligen 1 (866) 538-9510
Fax: 1 (866) 539-0365
http://IDMedicaid.Telligen.com
Healthy Connections Regional Health Resource Coordinators
Region I
Coeur d'Alene
1 (208) 666-6766
1 (800) 299-6766
Region II
Lewiston
1 (208) 799-5088
1 (800) 799-5088
Region III
Caldwell
1 (208) 455-7244
1 (208) 642-7006
1 (800) 494-4133
Region IV
Boise
1 (208) 334-0717
1 (208) 334-0718
1 (800) 354-2574
Region V
Twin Falls
1 (208) 736-4793
1 (800) 897-4929
Region VI
Pocatello
1 (208) 235-2927
1 (800) 284-7857
Region VII
Idaho Falls
1 (208) 528-5786
1 (800) 919-9945
In Spanish
(en Español)
1 (800) 378-3385
Insurance Verification
HMS
PO Box 2894
Boise, ID 83701
1 (800) 873-5875
1 (208) 375-1132
Fax: 1 (208) 375-1134
MedicAide September 2018 Page 14 of 16
Molina Provider and Participant Services Contact Information
Provider Services
MACS
(Medicaid Automated Customer Service)
1 (866) 686-4272
1 (208) 373-1424
Provider Service Representatives
Monday through Friday, 7 a.m. to 7 p.m. MT
1 (866) 686-4272
1 (208) 373-1424
E-mail [email protected]
[email protected]
Mail P.O. Box 70082
Boise, ID 83707
Participant Services
MACS
(Medicaid Automated Customer Service)
1 (866) 686-4752
1 (208) 373-1432
Participant Service Representatives
Monday through Friday, 7 a.m. to 7 p.m. MT
1 (866) 686-4752
1 (208) 373-1424
E-mail [email protected]
Mail – Participant Correspondence P.O. Box 70081
Boise, ID 83707
Medicaid Claims
Utilization Management/Case Management P.O. Box 70084
Boise, ID 83707
CMS 1500 Professional P.O. Box 70084
Boise, ID 83707
UB-04 Institutional P.O. Box 70084
Boise, ID 83707
UB-04 Institutional
Crossover/CMS 1500/Third-Party Recovery
(TPR)
P.O. Box 70084
Boise, ID 83707
Financial/ADA 2006 Dental P.O. Box 70087
Boise, ID 83707
Molina Provider Services Fax Numbers
Provider Enrollment 1 (877) 517-2041
Provider and Participant Services 1 (877) 661-0974
MedicAide September 2018 Page 15 of 16
Provider Relations Consultant (PRC) Information
Region 1 and the state of Washington 1 (208) 559-4793
[email protected]
Region 2 and the state of Montana 1 (208) 991-7138
[email protected]
Region 3 and the state of Oregon
1 (208) 860-4682 [email protected]
Region 4 and all other states 1 (208) 912-3970 [email protected]
Region 5 and the state of Nevada 1 (208) 484-6323 [email protected]
Region 6 and the state of Utah 1 (208) 870-3997 [email protected]
Region 7 and the state of Wyoming 1 (208) 991-7149 [email protected]
MedicAide September 2018 Page 16 of 16
Digital Edition
MedicAide is available online by the fifth of each month at www.idmedicaid.com. There may be
occasional exceptions to the availability date as a result of special circumstances. The electronic
edition reduces costs and provides links to important forms and websites. To request a paper
copy, please call 1 (866) 686-4272.
Molina Medicaid Solutions
PO Box 70082
Boise, Idaho 83707
MedicAide is the monthly
informational newsletter for
Idaho Medicaid providers.
Editors: Shelby Spangler and Shannon
Tolman
If you have any comments or suggestions,
please send them to:
Shelby Spangler,
[email protected]
Shannon Tolman,
[email protected]
Medicaid – Communications Team
P.O. Box 83720
Boise, ID 83720-0009 Fax: 1 (208) 364-1811
