1. Section Modifications

Transcription

1 Idaho MMIS Table of Contents 1. Section Modifications Introduction Division of Medicaid Participant Service Numbers Idaho Cities by Medicaid Region Children s Developmental Disabilities (DD) Program Healthy Connections (HC) Prior Authorization (PA) Contacts Regional Medicaid Services (RMS) Third Party Recovery (TPR) and Crossover Claim Contacts Molina Medicaid Solutions MACS Addresses and Phone Numbers Molina Regional Provider Relations Consultants (PRCs) October 20, 2017 Page i

2 Idaho MMIS 1. Section Modifications Version Section / Column Modification Description Publish Date SME 26.0 All Published version 10/20/17 TQD Idaho Cities by Medicaid Region Added Anthony to Region 7 10/20/17 D Baker E Garibovic 25.0 All Published version 6/27/17 TQD Molina Provider Relations Conultants (PRCs) Updated Region 4 and Region 7 phone numbers 6/27/17 D Baker E Garibovic Introduction Updated Idaho Smiles link 6/27/17 D Baker 24.0 All Published version 2/1/17 TQD Prior Authorization (PA) Contacts Updated dental vendor information for vendor change 2/1/17 F Clarke D Baker E Garibovic Introduction Updated dental vendor information for vendor change 2/1/17 F Clarke D Baker E Garibovic 23.0 All Published version 8/31/16 TQD Introduction Updated QIO information due to vendor 8/31/16 D Baker 8. Prior Authorization (PA) Contacts change 22.0 All Published version 5/31/16 TQD Prior Authorization (PA) Updated Non-Emergency Medical 5/31/16 D Baker Contacts Transportation vendor 21.0 All Published version 12/3/15 TQD Introduction Added phone number for MMCP 12/3/15 K Gudmunson D Baker 20.0 All Published version 8/14/15 TQD Idaho Cities by Medicaid Region Added Onoway to Region 2 8/14/15 K Irby D Baker 19.0 All Published version 6/4/15 TQD Idaho Cities by Medicaid Region Added Hollister to Region 5 6/4/15 K Irby C Taylor 18.0 All Published version 12/18/14 TQD Idaho Cities by Medicaid Region Added Driggs to Region 7 12/18/14 K Irby D Baker 17.0 All Published version 11/24/14 TQD Introduction 3. Division of Medicaid 8. Prior Authorization (PA) Contacts Updated contact information 11/24/14 A Coppinger C Taylor 16.0 All Published version 09/11/14 TQD Regional Provider Removed Region 8 09/11/14 C Taylor Relations Consultants (PRCs) 15.0 All Published version 09/02/14 TQD Regional Provider Updated address for Region 5 09/02/14 C Taylor Relations Consultants (PRCs) 14.0 All Published version 02/21/14 TQD Idaho Cities by Medicaid Region Removed Council from Region 4 02/21/14 R Natal D Baker C Taylor 13.0 All Published version 01/17/14 TQD Regional Provider Relations Consultants (PRCs) Updated Region 8 description; added Molina to section title. 01/17/14 D Baker C Taylor October 20, 2017 Page 1 of 12

3 Idaho MMIS Version Section / Column Modification Description Publish Date SME 12.0 All Published version 10/04/13 TQD Addresses and Phone Numbers Added Claims Review Request Form information 10/04/13 D Decrevel C Taylor Participant Service Numbers Updated numbers for Medicaid Non- Emergent Transportation 10/04/13 D Baker C Taylor 11.0 All Published version 08/30/13 TQD PRCs Added region 8 08/30/13 T Kinzler PA Contacts Removed Mental Health and Substance 08/30/13 C Burt Abuse 10.0 All Published version 06/24/13 D Baker Idaho Cities by Added Hauser to Region 1 06/24/13 K Irby Medicaid Region 9.0 All Published version 05/13/13 TQD Addresses and Phone Updated PO Boxes 05/13/13 D Decrevel Numbers 8.0 All Published version 03/14/13 TQD Division of Medicaid Put information in alpha order 03/14/13 TQD Third Party Recovery Updated information for Part B Medicare 03/14/13 C Taylor (TPR) and Crossover Claim Contacts 7.0 All Published version 02/21/13 TQD Addresses and Phone Updated Technical Services address 02/21/13 R Czerny Numbers 6.0 All Published version 09/21/12 TQD Regional PRCs Updated phone number for region four 09/21/12 D Schiller Addresses and Phone Updated PO Box for UB-04s 09/21/12 D Decrevel Numbers 5.0 All Published version 11/23/11 TQD Addresses and Phone Removed outdated information 11/23/11 D Decrevel Numbers 4.0 All Published version 07/29/11 TQD Prior Authorization Updated 07/29/11 R Baldwin (PA) Contacts Regional Provider Update PRC Region Information 07/29/11 J Gillet Relations Consultants (PRCs) 3.1 All Sections were renumbered to 07/29/11 TQD accommodate additional information 3.0 All Published version 03/11/11 TQD 2.0 All Published version 08/27/10 TQD 1.0 All Initial document Published version 05/07/10 TQD October 20, 2017 Page 2 of 12

4 Idaho MMIS 2. Introduction The directory contains contacts, addresses, telephone numbers, and fax numbers that providers may need. Providers may get information about the Idaho Medicaid Program on the Internet at the following sites: Idaho Medicaid Idaho Department of Health and Welfare (DHW) Centers for Medicare and Medicaid Services (CMS) Quality Improvement Organization (QIO) - Telligen Idmedicaid.telligen.com Optum Idaho Idaho Smiles MCNA American Medical Response Access2Care MMCP Medicare Medicaid Coordinated Plan Phone: 1 (888) Division of Medicaid Appeals Administrative Procedures PTC Building, 10 th floor 450 West State Street Boise, Idaho (208) Fax: 1 (208) Bureau of Developmental Disability Services 1 (208) Fax: 1 (208) Estate Recovery 1 (208) (866) Fax: 1 (866) October 20, 2017 Page 3 of 12

5 Idaho MMIS Bureau of Long-Term Care 1 (208) Medical Care Unit 1 (208) Fax: 1 (208) Medicaid Provider Fraud and Program Integrity Boise, ID prvfraud@dhw.idaho.gov 1 (208) Fax: 1 (208) Pharmacy and Medicaid Participant Lock-in 1 (208) (866) Fax: 1 (800) Preventive Health Assistance (PHA) Unit 1 (877) (208) Fax: 1 (877) Office of Mental Health and Substance Abuse 1 (208) (866) Fax: 1 (866) Financial Operations 1 (208) Fax: 1 (208) Participant Service Numbers Applications for Children's Health Insurance Program (CHIP) or 1 (800) (Idaho CareLine) Participant Line (English and Spanish) 1 (866) Fax: 1 (877) Idaho CareLine (English and Spanish) or 1 (800) Medicaid Non-Emergent Transportation 1 (208) or 1 (877) TTY 1(877) Idaho Nurse Aide Registry 1 (800) October 20, 2017 Page 4 of 12

6 5. Idaho Cities by Medicaid Region Region 1: Benewah, Bonner, Boundary, Kootenai, and Shoshone Counties Athol Clarkfork Desmit Hope Mullan Plummer Saint Maries Tensed Avery Clarkia Dover Kellogg Murray Ponderay Samuals Wallace Bayview Cocolalla Eastport Kingston Naples Port Hill Sandpoint Worley Blanchard Coeur d Alene Fernwood Kootenai Nordman Post Falls Santa Bonners Ferry Colburn Harrison Laclede Oldtown Priest River Silverton Calder Careywood Hauser Medimont Osburn Rathdrum Smelterville Cataldo Coolin Hayden Lake Moyie Springs Pinehurst Sagle Spirit Lake Region 2: Clearwater, Idaho, Latah, Lewis, and Nez Perce Counties Ahsahka Deary Grangeville Kendrick Lucille Peck Ruebens Viola Bovill Dixie Greencreek Keuterville Morgan s Valley Pierce Southwick Weippe Clearwater Elk City Harvard Kooskia Moscow Pollock Spalding White Bird Cottonwood Fenn Headquarters Lapwai Nez Perce Potlach Stites Winchester Craigmont Ferdinand Julietta Lenore Onaway Princeton Troy Culdesac Genesee Kamiah Lewiston Orofino Riggins University Region 3: Adams, Canyon, Gem, Owyhee, Payette, and Washington Counties Bruneau Emmett Greenleaf Letha Middleton New Meadows Oreana Weiser Caldwell Fruitland Homedale Marsing Midvale New Plymouth Owyhee Wilder Cambridge Fruitvale Huston Melba Murphy Notus Parma Council Grandview Indian Valley Mesa Nampa Ola Payette Region 4: Ada, Boise, Elmore, and Valley Counties Atlanta Crouch Garden City Idaho City McCall Pioneerville Warren Banks Donnelly Garden Valley King Hill Meridian Placerville West Mountain Boise Eagle Glenns Ferry Kuna Montour Smiths Ferry Yellow Pine Cascade Featherville Hammett Lowman Mountain Home Star Centerville Gardena Horseshoe Bend Lakefork Northside Sweet Region 5: Blaine, Camas, Cassia, Gooding, Jerome, Lincoln, Minidoka, and Twin Falls Counties Acequia Burley Eden Hailey Jerome Oakley Rupert Albion Carey Elba Hansen Ketchum Obsidian Shoshone Almo Castleford Fairfield Hazelton Kimberly Paul Sun Valley Bellevue Corral Filer Heyburn Malta Picabo Twin Falls Bliss Declo Gooding Hill City Minidoka Richfield Wendell Buhl Dietrich Hagerman Hollister Murtaugh Rogerson Region 6: Bannock, Bear Lake, Bingham, Caribou, Franklin, Oneida, and Power Counties Aberdeen Bern Dingle Geneva May Pingree Soda Springs Weston American Falls Blackfoot Downey Georgetown McCammon Pocatello Springfield Whitney Arbon Bloomington Firth Grace Mink Creek Portneuf Sterling Arimo Chubbuck Fish Haven Holbrook Montpelier Preston Sublett Atomic City Clifton Fort Hall Inkom Moreland Rockland Swan Lake Bancroft Conda Franklin Lava Springs Ovid Saint Charles Thatcher Basalt Dayton Freedom Malad City Paris Shelley Wayan Region 7: Bonneville, Butte, Clark, Custer, Fremont, Jefferson, Lemhi, Madison, and Teton Counties Ammon Clayton Grouse Ledmore Moore Roberts Tendoy Anthony Cobalt Hamer Lemhi Newdale Saint Anthony Terreton Arco Darlington Howe Leslie Northfork Salmon Teton Ashton Driggs Idaho Falls Lewisville Palisades Shoup Tetonia Butte City Dubois Iona Mackay Parker Stanley Ucon Carmen Ellis Irwin Macks Inn Rexburg Stone Victor Challis Felt Island Park Menan Rigby Sugar City Chester Gibbonsville Leadore Monteview Ririe Swan Valley October 20, 2017 Page 5 of 12

7 6. Children s Developmental Disabilities (DD) Program The Regional Children s DD Program is responsible for prior authorization (PA) of: DD service coordination (case management) for children. Intensive behavioral intervention by developmental disabilities agencies. Region Ironwood Court Coeur d Alene, ID (208) Region 2 P.O. Drawer B Lewiston, ID (208) Region Franklin Rd. Caldwell, ID (208) Region Westgate, Suite B Boise, ID (208) Region Harrison St. Twin Falls, ID (208) Region Memorial Dr. Pocatello, ID (208) Region Leslie Ave. Idaho Falls, ID (208) October 20, 2017 Page 6 of 12

8 7. Healthy Connections (HC) The HC Program is the name of Idaho Medicaid s Primary Care Case Management (PCCM) model of managed care. Questions regarding this program can be answered by calling one of the health resources coordinators in the regions listed below. Region 1 Region Ironwood, Suite 102 Coeur d Alene, ID (208) (800) Poleline Rd., Suite 3 Twin Falls, ID (208) (800) Region 2 Region F St. P.O. Drawer B Lewiston, ID (208) (800) Hiline, Suite 211 Pocatello, ID (208) (800) Region 3 Region Franklin Rd. Caldwell, ID (208) (800) N. Shoup St., Suite 20 Idaho Falls, ID (208) (800) N 16th Payette, ID (208) (800) Region Westgate, Suite A Boise, ID or Boise, ID (208) (800) Spanish Interpretive Service: For the HC Program statewide 1 (800) October 20, 2017 Page 7 of 12

9 8. Prior Authorization (PA) Contacts Dental MCNA - Idaho Smiles Program 1 (855) (Provider Relations) Hospital Inpatient and Select Medical Procedures Telligen 670 E Riverpark Ln. Suite 120 Boise, ID Phone 1 (866) Fax 1 (866) Help desk idmedicaidsupport@telligen.com Pharmacy Pharmacy Boise, ID (208) (866) Medical Equipment and Supplies DME Specialist, Medical Care Boise, ID (866) Fax: 1 (877) Attn: DME Specialist Website: Idmedicaid.telligen.com Preventive Health Assistance PHA Unit Boise, ID (877) (208) Fax: 1 (877) Transportation Non-Emergency Medical Transportation VEYO 1 (877) Fax: 1 (877) Medical and Surgical Medical Care Boise, ID Attention: Medical Authorizations 1 (208) Fax: 1 (877) Ambulance Review Medical Care Boise, ID Attention: Ambulance Review 1 (208) (800) Behavioral Health - Outpatient Optum Idaho 205 E. Water Tower Lane Meridian, ID (855) October 20, 2017 Page 8 of 12

10 9. Regional Medicaid Services (RMS) Region Ironwood Dr., Suite 102 Coeur d Alene, ID (208) Region F St. P.O. Drawer B Lewiston, ID (208) Region Franklin Rd. Caldwell, ID (208) Region Westgate, Suite A Boise, ID (208) Region Poleline, Suite 3 Twin Falls, ID (208) (800) Region Hiline Rd, Suite 260 Pocatello, ID (208) Region Shoup Ave. Suite 20 Idaho Falls, ID (208) October 20, 2017 Page 9 of 12

11 10. Third Party Recovery (TPR) and Crossover Claim Contacts HMS P.O. Box 2894 Boise, ID (208) (800) Monday through Friday (excluding holidays) 8 a.m. - 5:30 p.m. MT Part A Medicare (Both Regular and Railroad (RRB) Noridian Administrative Services LLC Medicare P.O. Box 6726 Fargo, ND Part B Medicare Noridian Administrative Services LLC Medicare P.O. Box 6726 Fargo, ND Provider 1 (877) (877) TTY Closed each Friday from 7:30-9:30 a.m. PT Beneficiary 1 (800) (800) Provider 1 (877) (877) TTY Closed each Friday from 7:30-9:30 a.m. PT Beneficiary 1 (800) (800) Part B Medicare (Railroad RRB only) Palmetto GBA, RRB Medicare Part B Provider 1 (877) P.O. Box Augusta, GA Beneficiary 1 (800) Medicare Hospice, Home Health, and Rural Health Claims United Government Services, LLC CA 1 (866) Medicare P.O. Box 9140 Oxnard, CA Durable Medical Equipment Regional Carrier (DMERC) * DMERC Region D Provider 1 (866) (CIGNA Health Care) P.O. Box 690 Public Relations 1 (866) Nashville, TN Beneficiary 1 (800) * DMERC Region D handles all durable medical equipment (DME), Beneficiary Claim immunosuppressive drugs, Services (automated)1 (877) enteral/parenteral nutrients (PEN), prosthetics, orthotics, and supplies October 20, 2017 Page 10 of 12

12 11. Molina Medicaid Solutions Health PAS-OnLine MACS Medicaid Automated Call Service (MACS) 1 (888) (208) MACS is available 24 hours a day, seven days a week. Provider service representatives are available Monday through Friday, 7:00 A.M.-7:00 P.M. MT Addresses and Phone Numbers Service Area Address Phone Fax Member Services IDMemberServices@MolinaHealthcare. com Provider Enrollment IDProviderEnrollment@MolinaHealthca re.com Provider Services IDProviderServices@MolinaHealthcare. com Technical Services IDEDISupport@Molinahealthcare.com P.O. Box P.O. Box P.O. Box Claims Review Request Form P.O. Box Utilization Management Case Management Healthy Connections CMS-1500 Claims UB-04 Crossover CMS1500 Crossover Third Party Recovery (TPR) UB04-Institutional Claims Financial/ADA 2006 Claims P.O. Box P.O. Box P.O. Box (866) (208) (866) (208) (866) (208) (866) (208) (877) (877) (877) (877) October 20, 2017 Page 11 of 12

13 11.3. Molina Regional Provider Relations Consultants (PRCs) Region 1 and the state of Washington Region.1@MolinaHealthCare.Com 1 (208) Region 2 and the state of Montana Region.2@MolinaHealthCare.Com 1 (208) Region 3 and the state of Oregon Region.3@MolinaHealthCare.Com 1 (208) Ironwood Dr., Suite 102 Coeur d Alene, ID F Street P.O. Drawer B Lewiston, ID Franklin Rd. Caldwell, ID Region 4 and all other states Region.4@MolinaHealthCare.Com 1 (208) W. Golden Trout Way Boise, ID Region 5 and the state of Nevada Region.5@MolinaHealthCare.Com 1 (208) Poleline Road, Suite 7 Twin Falls, ID Region 6 and the state of Utah Region.6@MolinaHealthCare.Com 1 (208) Hiline Rd. Pocatello, ID Region 7 and the state of Wyoming Region.7@MolinaHealthCare.Com 1 (208) Shoup Ave. Idaho Falls, ID October 20, 2017 Page 12 of 12