Information Releases

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1 An Informational Newsletter for Idaho Medicaid Providers From the Idaho Department of Health and Welfare, January 2018 Division of Medicaid In This Issue Attention Home Health Providers... 2 New Date for Trading Partner Account (TPA) Upgrade... 2 Eligibility Changes Effective January 1, My Choice Matters Website... 3 Reminder for DME Suppliers: Incontinence Supplies... 3 Attention All Providers: Unspecified Diagnoses Codes... 3 Idaho Medicare-Medicaid Coordinated Plan (MMCP) Update... 4 Medicaid Program Integrity... 5 Proposed Audit Guidelines for Medicaid Program Integrity Unit... 5 Idaho Medicaid Covered Benefits... 6 Reminder to All Hospital, Outpatient, and Professional Providers Billing Medications with HCPCS... 7 DMEPOS PA Policy and Medical Criteria... 8 CPT Coverage Added... 8 HCPCS Coverage Added...11 Provider Training Opportunities in Medical Care Unit Contact and Prior Authorization Information...27 DHW Resource and Contact Information...28 Insurance Verification...28 Molina Provider and Participant Services Contact Information...29 Molina Provider Services Fax Numbers...29 Provider Relations Consultant (PRC) Information...30 Information Releases MA17-05 New Payment Rates Effective January 1, MA17-06 Update to Idaho Medicaid Preferred Drug List MedicAide January 2018 Page 1 of 31

2 Attention Home Health Providers Reimbursement and Billing Requirements are Changing February 1 Home Health services are billed on a UB04 claim form and priced based on the Home Health fee schedule, available on the Idaho Medicaid webpage at Providers/Providers-Medicaid/MedicaidFeeSchedule/tabid/268/Default.aspx. Today this fee schedule shows that supplies and durable medical equipment (DME) will be manually priced. On and after 2/1/2018, the Home Health fee schedule will show that detailed coding is required for Revenue Codes 270 (supplies) and 291 (DME) and will price off of the numeric fee schedule, also available on the Idaho Medicaid webpage. Claims for services prior to February 1, 2018: Home Health providers can bill on one line using only the revenue code, adding all charges together. For example: Line 1: Rev code 270 charge $120 After February 1, 2018, each individual supply or piece of equipment will need to be billed using the appropriate CPT or HCPCS code. For example: Line 1: Rev code 270 Service code A4327 Charge $50.00 Line 2: Rev code 270 Service code A6540 Charge $70.00 New Date for Trading Partner Account (TPA) Upgrade The new TPA is coming!! The delay is over and the TPA upgrade is now scheduled to implement in January! Providers need to be ready with their TPA accounts which will be required after the upgrade. The TPA will allow providers to use two great new features: Secure Messaging and Provider/Billing Agent association. If you don t have your TPA yet, time is running out! TPA training is available to help you explore these new features and navigate the new look and feel of the portal. Providers can register for training by logging into the Idaho Medicaid Training Center at Or, you can review the training document at the Training link on Time (MT) 10:00 am 11:30 am 2:00 pm 3:30 pm Dates 1/12/2018 1/17/2018 1/19/2018 1/3/2018 1/4/2018 1/9/2018 1/10/2018 1/11/2018 1/16/2018 1/17/2018 1/18/2018 MedicAide January 2018 Page 2 of 31

3 Eligibility Changes Effective January 1, 2018 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 eligibility information will be displayed differently. 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. My Choice Matters Website Idaho s Division of Medicaid is pleased to announce the completion of the My Choice Matters website. This website has information related to services and supports for adults with intellectual and developmental disabilities in the State of Idaho. You will be able to find information about supports and services, and about rights and responsibilities. You will also find information about the KW Lawsuit and the work being done by Community NOW! On this website, you will also be able to provide feedback and submit questions directly to Idaho Medicaid. You can see the website by going to Please check back frequently as this website will be updated on a regular basis. Reminder for DME Suppliers: Incontinence Supplies Medicaid only covers Pull-ups for participants between the ages of four and twenty-one. If the participant is medically able, they must be in a formal toilet training program. Suppliers are required to maintain documentation of the toilet training program. See the Suppliers section of the Idaho Medicaid Provider Handbook for more information. Attention All Providers: Unspecified Diagnoses Codes As a reminder to providers, unspecified diagnoses codes should be the exception to coding. Claims should be coded to the highest level of specificity. Some services are restricted in the provider handbook or posted policies for specific circumstances as identified by diagnoses codes. If an unspecified code does not appear on these lists, but is the appropriate diagnosis, check the policy or handbook with the restriction for instructions on alternate billing options. For example, some policies may allow claims with a KX modifier for uncovered diagnoses. If alternate billing options aren t provided: For inpatient hospital stays, please, follow Telligen s default processes. For other claims follow the claim review and Medicaid review process. MedicAide January 2018 Page 3 of 31

4 Idaho Medicare-Medicaid Coordinated Plan (MMCP) Update Dental Benefit Changes Starting January 1, 2018, dental benefits for Medicare Medicaid Coordinated Plan (MMCP) members will be administered through Medicaid benefits. Providers servicing MMCP members for dental services will need to send dental claims directly to MCNA. Two MMCP Health Plan Choices Are Here Idaho Medicaid is excited to announce that there is a new health plan, in addition to Blue Cross of Idaho, that is now offering the Medicare-Medicaid Coordinated Plan (MMCP) effective January 1 st, The MMCP is a program available to Idaho Dual Eligible residents who are 21 or older and are eligible and enrolled in Medicare Part A and Part B and full Medicaid coverage. The program covers all medically necessary and preventive services covered under Medicare Part A, Part B, and Part D prescription drug coverage as well as most services covered by Medicaid, including Aged and Disabled Waiver, behavioral health services, personal care services, and Targeted Service Coordination for individuals with developmental disabilities. The program also includes a care coordination component to ensure that Medicare and Medicaid services are integrated and meet each participants unique needs. Counties that currently have an option of a Blue Cross of Idaho or Molina Healthcare MMCP plan are: Ada, Bannock, Bingham, Bonner, Bonneville, Canyon, Kootenai, Nez Perce, and Twin Falls Blue Cross of Idaho also offers the MMCP in the following additional counties: Boise, Boundary, Cassia, Clark, Elmore, Fremont, Gem, Jefferson, Madison, Minidoka, Owyhee, Payette, Power The counties that do not have MMCP option are: Adams, Bear Lake, Benewah, Blaine, Butte, Camas, Caribou, Clearwater, Custer, Franklin, Gooding, Idaho, Jerome, Latah, Lemhi, Lewis, Lincoln, Oneida, Shoshone, Teton, Valley, Washington. Participants residing in these counties will remain with the Medicare Fee For Service (FFS)/Idaho Medicaid that they are currently on. With two active Health Plans administering the MMCP, checking eligibility will be crucial to ensure correct billing practices because providers must bill the appropriate Health Plan, not the Idaho Health PAS, for services covered under the MMCP. Providers who wish to provide services for participants enrolled in the MMCP or have questions, can contact the Health Plans directly to become a participating provider of the Health Plan. Providers who wish to join the MMCP in 2018 or have questions, contact: Blue Cross of Idaho 1 (888) or Contact the regional provider relations department Molina Healthcare 1 (844) MedicAide January 2018 Page 4 of 31

5 Medicaid Program Integrity NCCI Edits The Medicaid Program Integrity Unit wants to remind providers that claims billed to Idaho Medicaid must be in accordance with the coding policies and guidelines as defined in the American Medical Association s Current Procedural Terminology (CPT) Manual as well as the National Correct Coding Initiative (NCCI) policy and edits. NCCI is a program of coding policies and edits established by the Centers for Medicare and Medicaid services, and have been in effect with Idaho Medicaid since April 1, The NCCI edits are based on coding policies and conventions defined in the American Medical Association s CPT Manual, national Medicare policies, coding guidelines developed by national societies, standard medical and surgical practices, and current coding practices. NCCI edits apply to claims that include the same provider, same participant and the same date of service. These edits include: Procedure-to-procedure (PTP) define pairs of Healthcare Common Procedure Coding System (HCPCS) and CPT codes that should not be reported together. Medically unlikely edits (MUEs) define maximum number of units of service allowable, under most circumstances, for a single HCPCS/CPT code. Modifiers should only be used when appropriate. In general, these circumstances relate to separate patient encounters, separate anatomic sites or separate specimens. Examples of NCCI PTP-associate modifiers are: 24, 25, 27, 57, 58, 59, 78, and 79. Additional information regarding NCCI edits can be found in the Medicaid NCCI Policy Manual. Proposed Audit Guidelines for Medicaid Program Integrity Unit The Medicaid Program Integrity (MPI) Unit is creating unit audit guidelines and is encouraging Medicaid providers to provide input on the following: Defining what is considered repeated or substantial for purposes of assessing civil monetary penalties (CMP) Describing when statistical sampling is used Describing when overpayments are extrapolated Describing method for calculating extrapolated overpayments Describing when and how to extrapolate CMPs Medicaid providers can review the proposed guidelines and provide feedback by completing the survey at The survey will be available between January 15 and 31, Once survey results are tallied, the MPI Unit will schedule meetings in Eastern Idaho, Boise, and Northern Idaho. At the meetings, attendees will have the opportunity to review survey results and provide additional feedback. MedicAide January 2018 Page 5 of 31

6 Idaho Medicaid Covered Benefits Usual and Customary is the Provider s Fee Charged To and Collected From the General Public This information below appears on the State webpage, Providers Medicaid. This page includes the Idaho Medicaid Physician Fee Schedule and specialty fee schedules for distinct provider types and specialties such as Home Health, Independent Therapy, School-Based Services, etc. The meaning of usual and customary is standard to the entire healthcare industry for medical, surgical, durable medical equipment, and medical supplies. Idaho Medicaid Fee Schedules links are available at idmedicaid.com and healthandwelfare.idaho.gov. What is an Idaho Medicaid Covered Benefit/Service? A CPT/HCPCS appearance on any Idaho Medicaid fee schedule is an informational-only list of reimbursable services. The billing provider is responsible for determinations of medical necessity, limitations of a participant s benefit plan, and appropriate coding and billing according the Idaho Medicaid policy, including national billing and correct coding standards as those standards apply to Idaho Medicaid reimbursement methodology. Medicaid Fee Schedules For most services, Idaho Medicaid reimburses providers the lesser of the billed amount or the maximum allowable fee established by the Idaho Department of Health and Welfare, Division of Medicaid. Any code listed may have a service limitation associated with it or need prior authorization from Medicaid or its designee. For more information, contact Molina Medicaid Solutions at 1 (866) Reimbursement rates may change during the year without an update to the fee schedule information. See the Reminders section below for additional information. How to Read It The numerical fee schedule contains at least the following: Procedure Code Numerical identifier (generally CPT or HCPCs) for medical services or supplies. Procedure Description Description of the procedure. For additional details, refer to the most current CPT or HCPCS code books. Reimbursement Dollar Amount - A Zero price does not mean it is not a covered service. It would be manually priced for reimbursement based on invoice. Refer to the General Billing Instructions in the Provider Handbook for more information. This information can be found on the Idaho Molina Medicaid website. Reminders When using the fee schedule, remember that Idaho Medicaid requires all providers to bill their usual and customary charge for services provided to Medicaid recipients. Therefore, providers should not use the fee schedule to set their rates. "Usual and customary charge" means the provider's charge for providing the same service to persons not eligible for Medicaid benefits. MedicAide January 2018 Page 6 of 31

7 Reminder to All Hospital, Outpatient, and Professional Providers Billing Medications with HCPCS Per Federal Rule, Idaho Medicaid may only reimburse providers for physician administered drugs and biologicals whose manufacturers participate in the Centers for Medicare & Medicaid Services (CMS) Drug Rebate Program. In order for the state to receive Federal match and invoice and collect rebates, the National Drug Code (NDC) linked to the HCPCS code for that drug must be submitted with the claim. Medical providers billing Idaho Medicaid using HCPCS codes (includes J Codes and Q codes) must include all required NDC information either on the appropriate electronic screen or on the NDC Detail Attachment for paper claims. This NDC code is present on all prescription medications as well as non-prescription (OTC) medications. If an invalid NDC is used or if the NDC does not match the J Code (e.g. NDC for a different drug than the J code used), the claim will deny. When completing the claim: Use the NDC number as it appears on the product package administered. Most NDCs are displayed on drug packing in a ten-digit format and must be converted to an 11-digit number for submission. (For instructions on converting NDCs from ten digits to 11 digits see 20PAD.pdf) Complete all required fields for NDC information when billing electronically or on paper including: NDC (11-digit number), units, basis of measurement (gram, milliliter, or unit). Verify that the correct unit or basis of measurement is being billed for that NDC (gram, milliliter, or unit). Verify that the number of units billed for the NDC has the correct conversion for the amount of drug administered. HCPCS units are billed by the number of units actually administered. The HCPCS procedure code description identifies the unit amount to calculate the number of units to be billed. NDC units are based upon the volume or the quantity administered to the patient. Do not bill using unclassified or unspecified drug codes unless there is no existing specific code for the drug being administered. The National Drug Code (NDC) and dosage given to the client must be included with the unclassified or unspecified drug code for coverage and payment consideration. Example A patient receives 4 mg Zofran IV in the physician s office. The J Code is J2405 and the NDC of the product used was (Zofran 2mg/ml in solution form). There are 2 milliliters per vial. The provider should bill J2405 (ondansetron hydrochloride, per 1 mg) with 4 HCPCS units and NDC units as 2 ML. NDC is Number of units is 2 Basis of measurement is MLS Incorrect billing of a drug HCPCS may result in excess paid units and is an overpayment that should be corrected by the billing provider. If the billing provider does not correct an overpayment, the claim may be recouped and civil monetary penalties may apply. MedicAide January 2018 Page 7 of 31

8 DMEPOS PA Policy and Medical Criteria The Medical Care Unit has composed a policy document in relation to Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS). This policy document has been prepared to provide information and guidance to DMEPOS providers who provide services to Idaho Medicaid participants. This material serves as an official communication and instruction guide established by the Department. The intention of this document is to help assist suppliers in understanding the prior authorization (PA) process and to clearly demonstrate to primary care physicians the medical criteria used in most circumstances related to DMEPOS. It is highly encouraged that providers take the time to read and review this document once available. This document is targeted to be available online beginning February 1, 2018 on the DME website under the Resources tab. CPT Coverage Added The following codes are being added for coverage. Please allow additional time for the system to be updated. Coverage is expected to be active in February. Code Description Effective Date Anesthesia for procedure on esophagus, stomach, and/or upper small bowel using an endoscope Anesthesia for diagnostic examination of gallbladder and pancreatic, liver, and bile ducts using an endoscope Anesthesia for procedure on large bowel using an endoscope Anesthesia for diagnostic examination of large bowel using an endoscope Anesthesia for procedure on esophagus, stomach, small bowel, and/or large bowel using an endoscope Creation of flap graft to midface Creation of flap graft to head and/or neck Tying of sphenopalatine artery using an endoscope Complete examination of nose and sinuses using an endoscope Complete examination of nose and sinuses and removal of nasal sinus using an endoscope Removal of tissue from sphenoid sinus using an endoscope Dilation of nasal sinus using an endoscope Destruction of growths in one lung, accessed through the skin Replacement of artificial heart Removal of artificial heart Placement of graft for repair of aorta including radiological supervision and interpretation Placement of graft for repair of aorta including radiological supervision and interpretation Placement of graft for repair of aorta and groin artery including radiological supervision and interpretation Placement of graft for repair of aorta and groin artery including radiological supervision and interpretation Placement of graft for repair of aorta and groin arteries including radiological supervision and interpretation MedicAide January 2018 Page 8 of 31

9 Code Description Effective Date Placement of graft for repair of aorta and groin arteries including radiological supervision and interpretation Placement of graft for repair of groin artery including radiological supervision and interpretation Placement of graft for repair of groin artery including radiological supervision and interpretation Insertion of prosthesis for repair of abdominal or groin artery including radiological supervision and interpretation Delayed insertion of prosthesis for repair of abdominal or groin artery Delayed insertion of prosthesis for repair of abdominal or groin artery Delivery of fixation device to graft via catheter including radiological supervision and interpretation Exposure of one groin artery for delivery of graft, accessed through the skin Exposure of one groin artery with creation of conduit, open procedure Exposure of one underarm or upper chest artery for delivery of prosthesis, open procedure Exposure of one underarm or upper chest artery with creation of conduit Injection of chemical agent into single incompetent vein of leg using ultrasound guidance Injection of chemical agent into multiple incompetent veins of same leg using ultrasound guidance Chemical destruction of incompetent vein of arm or leg, accessed through the skin using imaging guidance Chemical destruction of incompetent vein of arm or leg, accessed through the skin using imaging guidance Bone marrow biopsy and aspiration Removal of all lymph nodes of both sides of pelvis using an endoscope Removal of esophagus and partial removal of stomach using an endoscope Removal of lower esophagus and partial removal of stomach using an endoscope Removal of esophagus using an endoscope Removal of uterus for tumor debulking using a laparoscope X-ray of chest, 1 view X-ray of chest, 2 views X-ray of chest, 3 views X-ray of chest, minimum of 4 views X-ray of abdomen, 1 view X-ray of abdomen, 2 views X-ray of abdomen, minimum of 3 views Gene analysis (Human Platelet Antigen 1) for common variant Gene analysis (Human Platelet Antigen 2) for common variant Gene analysis (Human Platelet Antigen 3) for common variant MedicAide January 2018 Page 9 of 31

10 Code Description Effective Date Gene analysis (Human Platelet Antigen 4) for common variant Gene analysis (Human Platelet Antigen 5) for common variant Gene analysis (Human Platelet Antigen 6) for common variant Gene analysis (Human Platelet Antigen 9) for common variant Gene analysis (Human Platelet Antigen 15) for common variant Gene analysis (isocitrate dehydrogenase 1 [NADP+], soluble) for common variants Gene analysis (isocitrate dehydrogenase 2 [NADP+], mitochondrial) for common variants Gene analysis (additional sex combs like 1, transcriptional regulator) full sequence analysis Gene analysis (additional sex combs like 1, transcriptional regulator) targeted sequence analysis Gene analysis (coagulation factor IX) full sequence analysis Gene analysis (glucose-6-phosphate dehydrogenase) for common variant Gene analysis (glucose-6-phosphate dehydrogenase) for known familial variant Gene analysis (glucose-6-phosphate dehydrogenase) full sequence analysis Gene analysis (alpha globin 1 and alpha globin 2) for known familial variant Gene analysis (alpha globin 1 and alpha globin 2) full sequence analysis Gene analysis (alpha globin 1 and alpha globin 2) for duplication/deletion variants Gene analysis (runt related transcription factor 1) targeted sequence analysis Gene analysis (hemoglobin, subunit beta) for common variant Gene analysis (hemoglobin, subunit beta) for known familial variant Gene analysis (hemoglobin, subunit beta) for duplication/deletion variant Gene analysis (hemoglobin, subunit beta) full sequence analysis Gene analysis panel for hereditary disorders of the peripheral nervous system Measurement of antibody (IgE) to allergic substance Analysis for antibody to Zika virus Detection test for respiratory syncytial virus Detection test for Zika virus Vaccine for influenza for injection into muscle Training for home international normalized ratio (INR) monitoring of blood thinner therapy Anti-clotting management for patient taking warfarin Exercise test for spasm of lung airways Test for exercise-induced lung stress Continuous monitoring of glucose in tissue fluid using sensor under skin MedicAide January 2018 Page 10 of 31

11 Code Description Effective Date Application of light and light-sensitive drugs to aid destruction of premalignant skin growths, per day Application of light and light-sensitive drugs following removal of premalignant thickened skin growth, per day Advance care planning including the explanation and discussion of advance directives such as standard forms (with completion of such forms, when performed), by the physician or other qualified health care professional; first 30 minutes, face-to-face with the patient, family member(s), and/or surrogate Advance care planning including the explanation and discussion of advance directives such as standard forms (with completion of such forms, when performed), by the physician or other qualified health care professional; each additional 30 minutes (List separately in addition to code for primary procedure) HCPCS Coverage Added The following codes are being added for coverage. Please allow additional time for the system to be updated. Coverage is expected to be active in February. Code Description Effective Date E0953 Wheelchair accessory, lateral thigh or knee support, any type including fixed mounting hardware, each E0954 Wheelchair accessory, foot box, any type, includes attachment and mounting hardware, each foot G0249 Provision of test materials and equipment for home INR monitoring of patient with either mechanical heart valve(s), chronic atrial fibrillation, or venous thromboembolism who meets Medicare coverage criteria; includes: provision of materials for use in the home and reporting of test results to physician; testing not occurring more frequently than once a week; testing materials, billing units of service include 4 tests G8431 Screening for depression is documented as being positive and a follow-up plan is documented G8510 Screening for depression is documented as negative, a follow-up plan is not required J0565 Injection, bezlotoxumab, 10 mg J0604 Cinacalcet, oral, 1 mg, (for esrd on dialysis) J0606 Injection, etelcalcetide, 0.1 mg J1428 Injection, eteplirsen, 10 mg J1555 Injection, immune globulin (cuvitru), 100 mg J1627 Injection, granisetron, extended-release, 0.1 mg J1726 Injection, hydroxyprogesterone caproate, (makena), 10 mg J1729 Injection, hydroxyprogesterone caproate, not otherwise specified, 10 mg J2326 Injection, nusinersen, 0.1 mg J2350 Injection, ocrelizumab, 1 mg J3358 Ustekinumab, for intravenous injection, 1 mg MedicAide January 2018 Page 11 of 31

12 Code Description Effective Date J7210 Injection, factor viii, (antihemophilic factor, recombinant), (afstyla), 1 i.u. J7211 Injection, factor viii, (antihemophilic factor, recombinant), (kovaltry), 1 i.u. J7296 Levonorgestrel-releasing intrauterine contraceptive system, (kyleena), 19.5 mg J7345 Aminolevulinic acid hcl for topical administration, 10% gel, 10 mg J9022 Injection, atezolizumab, 10 mg J9023 Injection, avelumab, 10 mg J9203 Injection, gemtuzumab ozogamicin, 0.1 mg J9285 Injection, olaratumab, 10 mg L3761 Elbow orthosis (eo), with adjustable position locking joint(s), prefabricated, off-the-shelf L7700 Gasket or seal, for use with prosthetic socket insert, any type, each L8625 External recharging system for battery for use with cochlear implant or auditory osseointegrated device, replacement only, each L8694 Auditory osseointegrated device, transducer/actuator, replacement only, each P9073 Platelets, pheresis, pathogen-reduced, each unit P9100 Pathogen(s) test for platelets Q0477 Power module patient cable for use with electric or electric/pneumatic ventricular assist device, replacement only Q2040 Tisagenlecleucel, up to 250 million car-positive viable t cells, including leukapheresis and dose preparation procedures, per infusion MedicAide January 2018 Page 12 of 31

13 Figure 1: MA17-05 New Payment Rates Effective January 1, 2018 MedicAide January 2018 Page 13 of 31

14 Figure 2: MA17-06 Update to Idaho Medicaid Preferred Drug List MedicAide January 2018 Page 14 of 31

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26 Provider Training Opportunities in 2018 You are invited to attend the following webinars offered by Molina Medicaid Solutions Regional Provider Relations Consultants. January: Trading Partner Account Upgrade and Eligibility Changes Overview This training will walk all providers through the upgraded Trading Partner Account (TPA) portal. Providers will learn how to navigate the new site and how to utilize new functionality such as Secure Messaging and billing agent/provider association requests. This training session will also provide an overview of the eligibility changes effective in January. 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 10:00-11:30 AM MT January February March TPA Upgrade/ Eligibility Changes 1/12/2018 Eligibility Coordination of Benefits 2/14/2018 3/1/2018 1/17/ :00-11:00 2/15/2018 3/14/2018 1/19/2018 AM MT 2/20/2018 3/15/2018 3/26/2018 2:00-3:30 PM MT 1/3/2018 2/6/2018 3/8/2018 1/4/2018 2/8/2018 3/15/2018 1/9/2018 2/14/2018 3/20/2018 1/10/2018 2:00-3:00 PM 2/15/2018 1/11/2018 MT 1/16/2018 1/17/2018 1/18/2017 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 30 of this newsletter. MedicAide January 2018 Page 26 of 31

27 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 Prior authorization request forms containing the fax to number can be found at 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 Boise, ID 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 Choose Form Entry, then choose Authorization Status. 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 To speak to a Molina Medicaid Solutions representative, call 1 (866) , option 3. MCU Medical Review Decisions If you have any questions about medical review decisions, please refer to the following contact numbers or MedicalCareUnit@dhw.idaho.gov. Fax Number Phone Number Administratively Necessary Days 1 (877) (866) Ambulance* 1 (877) (800) Breast & Cervical Cancer 1 (877) (208) Durable Medical Equipment 1 (877) (866) Hospice 1 (877) (866) Preventive Health Assistance 1 (877) (208) Service Coordination 1 (877) (866) Surgery-Procedure-Lab 1 (877) (866) Therapy: OT, PT, SLP 1 (877) (866) Vision 1 (877) (866) * Idaho Medicaid contracts with Veyo Logistics for all non-emergency medical transportation services. Please go to or call 1 (877) for more information. MedicAide January 2018 Page 27 of 31

28 DHW Resource and Contact Information DHW Website Idaho CareLine (800) Medicaid Program Integrity Unit P.O. Box Boise, ID prvfraud@dhw.idaho.gov Fax: 1 (208) Telligen 1 (866) Fax: 1 (866) Healthy Connections Regional Health Resource Coordinators Region I Coeur d'alene Region II Lewiston Region III Caldwell Region IV Boise Region V Twin Falls Region VI Pocatello Region VII Idaho Falls In Spanish (en Español) 1 (208) (800) (208) (800) (208) (208) (800) (208) (208) (800) (208) (800) (208) (800) (208) (800) (800) Insurance Verification HMS PO Box 2894 Boise, ID (800) (208) Fax: 1 (208) MedicAide January 2018 Page 28 of 31

29 Molina Provider and Participant Services Contact Information Provider Services MACS (Medicaid Automated Customer Service) Provider Service Representatives Monday through Friday, 7 a.m. to 7 p.m. MT Mail Participant Services MACS (Medicaid Automated Customer Service) Participant Service Representatives Monday through Friday, 7 a.m. to 7 p.m. MT Mail Participant Correspondence Medicaid Claims Utilization Management/Case Management CMS 1500 Professional UB-04 Institutional UB-04 Institutional Crossover/CMS 1500/Third-Party Recovery (TPR) Financial/ADA 2006 Dental 1 (866) (208) (866) (208) idproviderservices@molinahealthcare.com idproviderenrollment@molinahealthcare.com P.O. Box Boise, ID (866) (208) (866) (208) idparticipantservices@molinahealthcare.com P.O. Box Boise, ID P.O. Box Boise, ID P.O. Box Boise, ID P.O. Box Boise, ID P.O. Box Boise, ID P.O. Box Boise, ID Molina Provider Services Fax Numbers Provider Enrollment 1 (877) Provider and Participant Services 1 (877) MedicAide January 2018 Page 29 of 31

30 Provider Relations Consultant (PRC) Information Region 1 and the state of Washington 1120 Ironwood Drive Suite 102 Coeur d Alene, ID (208) Region.1@MolinaHealthCare.com Region 2 and the state of Montana 1118 F Street P.O. Box Drawer B Lewiston, ID (208) Region.2@MolinaHealthCare.com Region 3 and the state of Oregon 3402 Franklin Caldwell, ID (208) Region.3@MolinaHealthCare.com Region 4 and all other states 1720 Westgate Drive, Suite A Boise, ID (208) Region.4@MolinaHealthCare.com Region 5 and the state of Nevada 601 Poleline Road, Suite 7 Twin Falls, ID (208) Region.5@MolinaHealthCare.com Region 6 and the state of Utah 1070 Hiline Road Pocatello, ID (208) Region.6@MolinaHealthCare.com Region 7 and the state of Wyoming 150 Shoup Avenue Idaho Falls, ID (208) Region.7@MolinaHealthCare.com MedicAide January 2018 Page 30 of 31

31 Molina Medicaid Solutions PO Box Boise, Idaho Digital Edition MedicAide is available online by the fifth of each month at 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) 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, Shelby.Spangler@dhw.idaho.gov Shannon Tolman, Shannon.Tolman@dhw.idaho.gov Medicaid Communications Team P.O. Box Boise, ID Fax: 1 (208) MedicAide January 2018 Page 31 of 31