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Provider Handbook UpdatesUse SHIFT+ENTER to open the menu (new window).
Updates have been made to the Provider Handbook. You may find the link on the left navigation panel of this website. Changes are noted at the beginning of each document. The updated documents are:
  • General Provider and Participant Information
  • Physician Assistants, Advanced Practice Nursing
  • Suppliers
Healthy Connections RostersUse SHIFT+ENTER to open the menu (new window).
The December Healthy Connections Rosters have been posted to your secure Trading Partner Account.
Eligibility Changes Effective January 1, 2018Use SHIFT+ENTER to open the menu (new window).

Beginning January 1, 2018, the following changes will be visible when checking member eligibility through your Trading Partner Account.

  • Youth Empowerment Services (YES) condition.
  • Idaho Smiles and Idaho Behavioral Health Plan segments will no longer be visible effective after date of service 1/31/2017.
  • Members will show multiple PCP Assignments in addition to their Healthy Connections PCP. A PCP listing will display for each Managed Care Organization (i.e., Transportation, Dental, Behavioral Health, and MMCP) for which a member has coverage.

Molina is offering WebEx training sessions to review the changes in detail; refer to the Training Calendar for dates and times.

MMCP Expansion Effective January 1, 2018 Use SHIFT+ENTER to open the menu (new window).

Beginning January 1, 2018, Molina Healthcare of Idaho, in addition to Blue Cross of Idaho, Care Plus, will be offering the Medicare-Medicaid Coordinated Plan (MMCP).  The following resources are available to help you learn more about the MMCP expansion.

  • The Idaho Medicare-Medicaid Coordinated Plan (MMCP) Update article in the December 2017 MedicAide newsletter
  • WebEx training sessions available; refer to the Training Calendar for dates and times

For questions, contact Blue Cross of Idaho, Care Plus at 1 (888) 495-2583 or Molina Healthcare of Idaho at 1 (888) 562-5442 ext. 179564.

Trading Partner Account (TPA) Upgrade Trainings Offered in December and JanuaryUse SHIFT+ENTER to open the menu (new window).

The TPA portal is being updated in December, and all providers will be required to have a TPA account.  The portal is getting a new look and two new features will be introduced:  Secure Messaging and Provider/Billing Agent association.  To learn more about why you will need to have a TPA account, how to navigate the new site, and how to use these new features, sign up for the TPA upgrade training on any of the dates and times below.  You can register for these training sessions by logging into the Idaho Medicaid Training Center.  You may also view the training document by clicking here.  

 

 

December

January

10:00 - 11:00
AM MT

12/13/2017

1/16/2018

12/19/2017

1/17/2018

12/20/2017

1/18/2018

12/21/2017

 

 

 

 

2:00 - 3:00
PM MT

12/14/2017

1/10/2018

12/19/2017

1/11/2018

12/21/2017

1/16/2018

 

1/18/2018

December MedicAide Newsletter Now OnlineUse SHIFT+ENTER to open the menu (new window).

The December 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.

Trading Partner Account (TPA) Upgrade: Are Your Credentialers Ready?Use SHIFT+ENTER to open the menu (new window).

ALL PROVIDERS:  The TPA portal is being upgraded next month. Are Your Credentialers Ready?

 

If you have a TPA account, it is critical that you ensure the individual responsible for your credentialing is added as a user under your account.  This individual MUST be able to log into your Trading Partner Account in order to perform enrollment and maintenance tasks after the portal is upgraded.

 

If you do not have a TPA account, register for one NOW at www.idmedicaid.com to avoid delays in claims processing and payments and to ensure you have access to enrollment and maintenance.

If you have any questions or need assistance, please contact your regional Provider Relations Consultant (PRC) or the Molina provider services line at 1 (866) 686-4272.

Attention Providers Submitting Secondary Claims through Your Trading Partner AccountUse SHIFT+ENTER to open the menu (new window).

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!Use SHIFT+ENTER to open the menu (new window).
It is very important that you dial a 1 when calling us. Please call 1 (866) 686-4272.
Thank you!
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