CurrentIdaho Department of Health and WelfarePolicy N/A

Medicaid Program Integrity Unit bulletin: provider billing rules, payment rate changes, referrals, and contact information

Customize your policy alerts

Sign up for all Idaho Department of Health and Welfare policy alerts

Know when Idaho Department of Health and Welfare releases new policies or updates existing guidance.

Monitor payer policy activity

Receive email alerts as soon as relevant payer policies are published or updated.

A bulletin-style information release covering Program Integrity notices, provider billing rules, payment rate changes (effective July 1, 2014), service-specific guidance (including vision photoscreening coverage and home health caps), and regional contact resources for Idaho Medicaid providers and participants.

Policy Summary

PayerIdaho Department of Health and Welfare

PolicyMedicaid Program Integrity Unit bulletin: provider billing rules, payment rate changes, referrals, and contact information

Policy CodePolicy N/A

Change TypeInformation release (bulletin)

Effective DateJul 1, 2014

Next Review Date

Key ActionObtain and document Healthy Connections/Health Home referrals before rendering services; lack of a valid referral may make the service non-covered and subject to overpayment recovery.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

2014-07-01Effective date

99174New code covered

90%Reimbursement pct

$172.34Skilled Nursing cap

$217.98Speech Therapy cap

Coverage and Payment Criteria

Ocular photoscreening coverage

Covered when ALL of the following are met:

Procedure code 99174 (instrument-based ocular screening, bilateral) is covered when performed by a physician or a mid-level practitioner (advanced practice professional nurse or physician assistant).

One ocular photoscreening is considered medically necessary for all children at age 3.

Children ages 4–5 are eligible for photoscreening when they are unable to cooperate with routine acuity screening (for example: intellectual disability, developmental delay, or severe behavioral disorders).

Screening follows USPSTF guidance to detect amblyopia or its risk factors; evidence is insufficient to recommend routine screening for children under age 3.

Healthy Connections referral coverage stance

Referral-dependent coverage rules:

Services that require a Healthy Connections/Health Home referral are non-covered if a valid referral is not obtained and documented prior to providing the service.

A valid referral must include the core elements: name of the primary care provider granting the referral; date issued; duration (not to exceed one year); number of visits if applicable; specific scope/reason for referral; and referring diagnosis or condition; and must be documented in both referring and receiving patient records or entered online.

Referrals are required regardless of whether Medicaid is primary or secondary coverage; backdated or retroactive referrals are not valid.

If a required referral is missing, the Department will recover overpayments and may assess civil monetary penalties from providers who did not obtain and properly document referrals prior to providing services.

Provider billing options when referral missing

The service is considered non-covered and the provider may, with prior informed consent from the participant (preferably in writing), arrange a private pay agreement for the service.
Alternatively, the provider may refer the participant back to the Healthy Connections provider to obtain an appropriate referral before services are provided.

A covered service is defined as within the participant's benefit package, within service limits, and with applicable prior approval and/or referral requirements met; denial of a covered service may not be billed to the participant in the three specified denial circumstances (third-party liability, billing error, or late submission beyond one year).

Rate and cap changes

Payment rate and related policy changes effective July 1, 2014:

Providers must bill services with dates of service before July 1, 2014 separately from services with dates of service on or after July 1, 2014 to ensure correct payment under the new rates.

The Department updated reimbursement rates effective July 1, 2014 for multiple personal care, nursing, attendant care and related service codes (see MA14-03 for code-specific rates).

Non-primary care procedure codes are reimbursed at 90% of the current Medicare rate where a Medicare rate exists; if no Medicare rate exists, reimbursement is based on current Medicaid pricing.

Home health Medicaid cap limits for cost settlements are specified for dates of service July 1, 2014 through June 30, 2015; per-service caps and revenue codes are listed in the Home health service caps criteria group and in MA14-06.

Home health service caps

Medicaid cap limits for home health agency cost settlements for dates of service July 1, 2014 through June 30, 2015:

Skilled Nursing — revenue code 551; Medicaid cap limit = $172.34.

Physical Therapy — revenue code 421; Medicaid cap limit = $163.03.

Occupational Therapy — revenue code 431; Medicaid cap limit = $178.80.

Speech Therapy — revenue code 441; Medicaid cap limit = $217.98.

Home Health Aide — revenue code 571; Medicaid cap limit = $69.04.

Codes, Rates, and Reimbursement

Vision screeningCPTCovered

99174

Instrument-based ocular screening (e.g., photoscreening, automated-refraction), bilateral

Personal care and related service ratesmixedCovered

G9001	Coordinated Care Fee (Agency) - $99.04 per assessment
G9002	RN Care Plan Development and Placement - $10.19 per 15 minute unit
T1001	Nursing Assessment/Evaluation - $50.95 per visit
T1002	Nursing Services RN - $10.19 per 15 minute unit
T1003	Nursing Services LPN - $7.31 per 15 minute unit
S5125	Attendant Care Services - $3.94 per 15 minute unit
S5130	Homemaker Services - $3.55 per 15 minute unit

Home health revenue codes with cap contextmixedCovered

551	Revenue code for Skilled Nursing - cap $172.34
421	Revenue code for Physical Therapy - cap $163.03
431	Revenue code for Occupational Therapy - cap $178.80
441	Revenue code for Speech Therapy - cap $217.98
571	Revenue code for Home Health Aide - cap $69.04

inv-08: Reimbursement percentage

Reimbursement percentageMedicaid reimbursement rate set to 90% of the current Medicare rate for all non-primary care procedure codes (effective July 1, 2014)

Applies when Medicare rate existsIf a Medicare rate exists for the procedure code, Medicaid will reimburse at 90% of that rate

Fallback pricingWhere no Medicare rate is on file, payment is based on current Medicaid pricing

inv-09: Medicaid cap limits effective 7/1/2014–6/30/2015

Skilled Nursing capRevenue code 551 — cap $172.34

Physical Therapy capRevenue code 421 — cap $163.03

Occupational Therapy capRevenue code 431 — cap $178.80

Speech Therapy capRevenue code 441 — cap $217.98

Home Health Aide capRevenue code 571 — cap $69.04

Provider Responsibilities and Contact Points

Documentation Required

Secure and document Healthy Connections referrals prior to service

Obtain and document a valid Healthy Connections/Health Home referral, including all core elements, before providing services; lack of a valid referral renders the service non-covered and may trigger overpayment recovery and civil monetary penalties by the Department. Referrals are required regardless of payer status and backdated/retroactive referrals are not valid.

Core referral elements: referring PCP name; date issued; duration (≤ 1 year); number of visits if applicable; scope/reason; referring diagnosis
Referral must be documented in both referring and receiving records or entered online
Claims may process without a referral number, but provider remains responsible for documented referral prior to service

Billing Rule

Participant billing rules and denial exceptions

Do not bill participants for covered services except in the three specified circumstances; if a service is not covered, inform the participant in advance (preferably in writing) and obtain agreement before billing. If a covered service is denied for third-party liability, billing error, or late submission beyond one year, the provider may not bill the participant.

If service is not covered, obtain written participant consent before providing service and billing (example agreement language provided)
If a necessary Healthy Connections referral is missing, the service is considered non-covered and provider/participant may agree to a private pay arrangement
Denial for covered service — participant billing not allowed when: (1) third-party liable; (2) billing error — resubmit corrected claim; (3) billing submitted > 1 year after service (no earlier timely filing referenced)

Billing Rule

Separate billing by date-of-service for July 1, 2014 rate changes

Bill services with dates of service before July 1, 2014 separately from services on or after July 1, 2014 to ensure correct reimbursement under the new rates effective July 1, 2014.

Failure to separate date-segmented billing may result in payment errors
New code-specific rates (e.g., G9001, G9002, T1001, T1002, T1003, S5125, S5130) apply beginning July 1, 2014

Prior Authorization

Prior authorization sources and how to check status

Use the Medical Care Unit (MCU) web resources and idmedicaid.com for prior authorization requirements, Qualis review guidance, and to print PA request forms; MCU will not provide authorizations by telephone. Check authorization status via your Trading Partner Account (Form Entry > Authorization Status) and contact Molina Medicaid Solutions for assistance if needed.

PA request forms with 'fax to' numbers available at www.idmedicaid.com under Forms (DHW Forms heading)
MCU does not give authorizations over the telephone
To check authorization status: Trading Partner Account → Form Entry → Authorization Status; or call Molina 1 (866) 686-4272, option 3 for assistance

Note

Directory: Healthy Connections and Qualis Health contacts

Refer to the Department directory and Qualis Health web page for Healthy Connections Regional Health Resource Coordinators and Qualis Health contact information, including phone and fax numbers and the Qualis Health URL.

Qualis Health toll number: 1 (800) 783-9207
Qualis Health web resource: http://www.qualishealth.org/healthcare-professionals/idaho-medicaid
Fax contact listed for regional coordinators: 1 (208) 334-2026 (as shown in directory)

Note

Regional coordinator phone numbers and web link

Use the provided contact numbers and web link to reach Healthy Connections Regional Health Resource Coordinators for provider assistance; the directory lists multiple regional phone numbers and the Qualis Health web page for reference.

Region phone listings include local and toll-free numbers (e.g., 1 (208) 666-6766; toll-free 1 (800) 299-6766)
Qualis Health web resource: http://www.qualishealth.org/healthcare-professionals/idaho-medicaid

Note

Regional contact directory (Regions I–IV)

Consult the regional contact directory for phone listings of Healthy Connections Regional Health Resource Coordinators (Regions I–IV) that include both local and toll-free numbers for provider use.

Region I (Coeur d'Alene): 1 (208) 666-6766; toll-free 1 (800) 299-6766
Region II (Lewiston): 1 (208) 799-5088; toll-free 1 (800) 799-5088
Region III (Caldwell): 1 (208) 455-7244; additional contact 1 (208) 642-7006
Region IV (Boise): 1 (208) 334-0717

Note

Regional contact list by office

Reference the regional contact list for specific phone contact information for Healthy Connections Regional Health Resource Coordinators for Regions I (Coeur d'Alene), II (Lewiston), III (Caldwell), and IV (Boise).

Region IV (Boise) additional number shown: 1 (208) 334-0718
Toll-free contact repeats for several regions (e.g., 1 (800) 299-6766)

Documentation Required

Molina Provider and Participant Services contact details

Contact Molina Provider and Participant Services for claims, enrollment, participant inquiries, and utilization management using the MACS phone numbers, email addresses, and mailing addresses provided.

Provider Services MACS: 1 (866) 686-4272; Provider Service Representatives: 1 (208) 373-1424 or 1 (866) 686-4272 (Mon–Fri, 7 a.m.–7 p.m. MT)
Participant Services MACS: 1 (866) 686-4752 or 1 (208) 373-1432 (Mon–Fri, 7 a.m.–7 p.m. MT)
Email for provider services: idproviderservices@molinahealthcare.com; mailing addresses for claims and utilization management shown in directory

Documentation Required

Provider services fax numbers

Use designated fax numbers for Provider Enrollment and Provider and Participant Services when submitting documents or correspondence.

Provider Enrollment fax: 1 (877) 517-2041
Provider and Participant Services fax: 1 (877) 661-0974

Note

Region 3 (Caldwell) contact

For Region 3 matters (including Oregon), contact Rainy Natal at the Caldwell office listing: 3402 Franklin, Caldwell, ID 83605; phone 1 (208) 860-4682; email Region.3@MolinaHealthCare.com.

Office address: 3402 Franklin, Caldwell, ID 83605
Phone: 1 (208) 860-4682
Email: Region.3@MolinaHealthCare.com

Note

Region 4 (Boise) contact

For Region 4 and all other states, contact Robert Hughes at the Boise office: 1720 Westgate Drive, Suite A, Boise, ID 83704; phone 1 (208) 373-1343; email Region.4@MolinaHealthCare.com.

Office address: 1720 Westgate Drive, Suite A, Boise, ID 83704
Phone: 1 (208) 373-1343
Email: Region.4@MolinaHealthCare.com

Note

Region 5 (Twin Falls) contact

For Region 5 (and Nevada), contact Brenda Rasmussen at 803 Harrison St., Twin Falls, ID 83301; phone 1 (208) 484-6323; email Region.5@MolinaHealthCare.com.

Office address: 803 Harrison St., Twin Falls, ID 83301
Phone: 1 (208) 484-6323
Email: Region.5@MolinaHealthCare.com

Note

Region 6 (Pocatello) contact

For Region 6 (and Utah), contact Kelsey Gudmunson at 1070 Hiline Road, Pocatello, ID 83201; phone 1 (208) 870-3997; email Region.6@MolinaHealthCare.com.

Office address: 1070 Hiline Road, Pocatello, ID 83201
Phone: 1 (208) 870-3997
Email: Region.6@MolinaHealthCare.com

Note

Region 7 (Idaho Falls) contact

For Region 7 (and Wyoming), contact Kristi Harris at 150 Shoup Avenue, Idaho Falls, ID 83402; phone 1 (208) 991-7149; email Region.7@MolinaHealthCare.com.

Office address: 150 Shoup Avenue, Idaho Falls, ID 83402
Phone: 1 (208) 991-7149
Email: Region.7@MolinaHealthCare.com
Molina mailing address: PO Box 70082, Boise, Idaho 83707

Definitions and Terms

inv-25: Referral that must include core elements (referring PCP name, date issued, duration ≤ 1 year, number of visits if applicable, scope/reason, referring diagnosis) and be documented in both referring and receiving records or entered online.

Required referral elementsName of primary care provider, date issued, duration (≤ 1 year), number of visits (if applicable), specific scope/reason, referring diagnosis

Documentation locationsMust be documented in both the referring and receiving patient records or entered online

Timing requirementReferral must be obtained and documented prior to rendering services; backdated/retroactive referrals are not valid

inv-26: An objective, instrument-based screening method for preverbal or developmentally delayed children to detect amblyopia risk factors

DefinitionInstrument-based ocular screening (e.g., photoscreening, automated-refraction) for preverbal or developmentally delayed children

CPT codeProcedure code 99174

Clinical useUsed to detect amblyopia risk factors and screen children at age 3 or ages 4–5 who cannot cooperate with routine acuity screening

inv-27: Revenue Code (service type 1 indicates revenue code used to classify service)

MeaningService Type 1 denotes the revenue code used to classify the service

Example - Skilled NursingRevenue code 551 (Service Type 1) listed in home health caps

Example - Physical TherapyRevenue code 421 (Service Type 1) listed in home health caps

inv-28: Medicaid Cap Limits (monetary cap per service type for cost settlements)

DefinitionService Type 2 denotes the Medicaid cap limit (monetary cap per service type for cost settlements)

Format in bulletinEach service lists '1 = revenue code' and '2 = $cap' (e.g., Skilled Nursing, 2 = $172.34)

Effective periodCaps apply for dates of service July 1, 2014 through June 30, 2015

inv-29: Regional Health Resource Coordinators (Regions I–III): phone/fax contact points and web resource for provider support.

Primary contacts (Regions I–III)Region I (Coeur d'Alene): 1 (208) 666-6766; Region II (Lewiston): 1 (208) 799-5088; Region III (Caldwell): 1 (208) 455-7244

Toll/free and faxToll numbers listed include 1 (800) 299-6766 and other region toll numbers; Fax: 1 (208) 334-2026 (Qualis Health fax also 1 (800) 826-3836)

Web resourceQualis Health Idaho Medicaid page: http://www.qualishealth.org/healthcare-professionals/idaho-medicaid

inv-30: Healthy Connections Regional Health Resource Coordinators

SummaryHealthy Connections Regional Health Resource Coordinators serve as regional DHW contacts for Idaho Medicaid providers

Region phone listingsRegion I: 1 (208) 666-6766; Region II: 1 (208) 799-5088; Region III: 1 (208) 455-7244

Web linkRefer providers to: http://www.qualishealth.org/healthcare-professionals/idaho-medicaid

inv-31: Healthy Connections Regional Health Resource Coordinators

Regions I–IV coverageRegional coordinators listed for Regions I (Coeur d'Alene), II (Lewiston), III (Caldwell), and IV (Boise)

Region IV phoneRegion IV (Boise): 1 (208) 334-0717 (also 1 (208) 334-0718 in listings)

Toll-free contactGeneral toll numbers include 1 (800) 494-4133 for some listings

inv-32: Healthy Connections Regional Health Resource Coordinators

Regional phones repeatedRegion I: 1 (208) 666-6766; Region II: 1 (208) 799-5088; Region III: 1 (208) 455-7244; Region IV (Boise): 1 (208) 334-0717 / 1 (208) 334-0718

Toll numbersToll numbers shown in multiple chunks include 1 (800) 299-6766 and 1 (800) 494-4133

Use caseProviders should use these regional contacts for local Healthy Connections assistance and referrals guidance

inv-33: Healthy Connections Regional Health Resource Coordinators

Regional contact summaryListings repeat Region I–IV contacts including local, toll-free, and additional numbers for provider assistance

Region IV additional tollRegion IV listings include 1 (800) 354-2574 in some entries

ReferenceQualis Health web resource also provided for Idaho Medicaid professionals

inv-34: MACS

MACS Provider ServicesProvider Services MACS: 1 (866) 686-4272; Provider Service Representatives: 1 (208) 373-1424 / 1 (866) 686-4272

Participant Services MACSParticipant Services MACS: 1 (866) 686-4752; Participant Service Representatives: 1 (208) 373-1432 / 1 (866) 686-4752

Hours and contactPhone lines staffed Monday–Friday, 7 a.m. to 7 p.m. MT; email contact for provider services listed in source

inv-35: MedicAide

MedicAide descriptionMedicAide is the monthly informational newsletter for Idaho Medicaid providers, available online by the fifth of each month at www.idmedicaid.com

Paper copy requestTo request a paper copy, call 1 (866) 686-4272

Availability notesOccasional exceptions to the availability date may occur due to special circumstances

Policy Summary

PayerIdaho Department of Health and Welfare

PolicyMedicaid Program Integrity Unit bulletin: provider billing rules, payment rate changes, referrals, and contact information

Policy CodePolicy N/A

Change TypeInformation release (bulletin)

Effective DateJul 1, 2014

Next Review Date

Key ActionObtain and document Healthy Connections/Health Home referrals before rendering services; lack of a valid referral may make the service non-covered and subject to overpayment recovery.

SourceLink

On This Page

OpenPayer is powered by Trek Health's payer performance platform. Trek continuously ingests, validates, and normalizes Transparency in Coverage data alongside payer policies and other commercial payer data to create a structured payer intelligence foundation. OpenPayer uses this foundation to deliver personalized search results, dynamically generated policy pages, and tailored policy monitoring based on each user's payers, specialties, billing codes, and areas of interest. The same intelligence powers broader payer performance workflows, including reimbursement benchmarking, contract evaluation, payer negotiations, and financial decision-making.

Medicaid Program Integrity Unit bulletin: provider billing rules, payment rate changes, referrals, and contact information

Customize your policy alerts

Sign up for all Idaho Department of Health and Welfare policy alerts

Know when Idaho Department of Health and Welfare releases new policies or updates existing guidance.

Monitor payer policy activity

Receive email alerts as soon as relevant payer policies are published or updated.

Coverage and Payment Criteria

Ocular photoscreening coverage

Covered when ALL of the following are met:

Procedure code 99174 (instrument-based ocular screening, bilateral) is covered when performed by a physician or a mid-level practitioner (advanced practice professional nurse or physician assistant).

One ocular photoscreening is considered medically necessary for all children at age 3.

Screening follows USPSTF guidance to detect amblyopia or its risk factors; evidence is insufficient to recommend routine screening for children under age 3.

Healthy Connections referral coverage stance

Referral-dependent coverage rules:

Services that require a Healthy Connections/Health Home referral are non-covered if a valid referral is not obtained and documented prior to providing the service.

Referrals are required regardless of whether Medicaid is primary or secondary coverage; backdated or retroactive referrals are not valid.

Provider billing options when referral missing

The service is considered non-covered and the provider may, with prior informed consent from the participant (preferably in writing), arrange a private pay agreement for the service.
Alternatively, the provider may refer the participant back to the Healthy Connections provider to obtain an appropriate referral before services are provided.

Rate and cap changes

Payment rate and related policy changes effective July 1, 2014:

Providers must bill services with dates of service before July 1, 2014 separately from services with dates of service on or after July 1, 2014 to ensure correct payment under the new rates.

The Department updated reimbursement rates effective July 1, 2014 for multiple personal care, nursing, attendant care and related service codes (see MA14-03 for code-specific rates).

Non-primary care procedure codes are reimbursed at 90% of the current Medicare rate where a Medicare rate exists; if no Medicare rate exists, reimbursement is based on current Medicaid pricing.

Home health service caps

Medicaid cap limits for home health agency cost settlements for dates of service July 1, 2014 through June 30, 2015:

Skilled Nursing — revenue code 551; Medicaid cap limit = $172.34.

Physical Therapy — revenue code 421; Medicaid cap limit = $163.03.

Occupational Therapy — revenue code 431; Medicaid cap limit = $178.80.

Speech Therapy — revenue code 441; Medicaid cap limit = $217.98.

Home Health Aide — revenue code 571; Medicaid cap limit = $69.04.

Codes, Rates, and Reimbursement

Vision screeningCPTCovered

99174

Instrument-based ocular screening (e.g., photoscreening, automated-refraction), bilateral

Personal care and related service ratesmixedCovered

G9001	Coordinated Care Fee (Agency) - $99.04 per assessment
G9002	RN Care Plan Development and Placement - $10.19 per 15 minute unit
T1001	Nursing Assessment/Evaluation - $50.95 per visit
T1002	Nursing Services RN - $10.19 per 15 minute unit
T1003	Nursing Services LPN - $7.31 per 15 minute unit
S5125	Attendant Care Services - $3.94 per 15 minute unit
S5130	Homemaker Services - $3.55 per 15 minute unit

Home health revenue codes with cap contextmixedCovered

551	Revenue code for Skilled Nursing - cap $172.34
421	Revenue code for Physical Therapy - cap $163.03
431	Revenue code for Occupational Therapy - cap $178.80
441	Revenue code for Speech Therapy - cap $217.98
571	Revenue code for Home Health Aide - cap $69.04

inv-08: Reimbursement percentage

Reimbursement percentageMedicaid reimbursement rate set to 90% of the current Medicare rate for all non-primary care procedure codes (effective July 1, 2014)

Applies when Medicare rate existsIf a Medicare rate exists for the procedure code, Medicaid will reimburse at 90% of that rate

Fallback pricingWhere no Medicare rate is on file, payment is based on current Medicaid pricing

inv-09: Medicaid cap limits effective 7/1/2014–6/30/2015

Skilled Nursing capRevenue code 551 — cap $172.34

Physical Therapy capRevenue code 421 — cap $163.03

Occupational Therapy capRevenue code 431 — cap $178.80

Speech Therapy capRevenue code 441 — cap $217.98

Home Health Aide capRevenue code 571 — cap $69.04

Provider Responsibilities and Contact Points

Documentation Required

Secure and document Healthy Connections referrals prior to service

Core referral elements: referring PCP name; date issued; duration (≤ 1 year); number of visits if applicable; scope/reason; referring diagnosis
Referral must be documented in both referring and receiving records or entered online
Claims may process without a referral number, but provider remains responsible for documented referral prior to service

Billing Rule

Participant billing rules and denial exceptions

If service is not covered, obtain written participant consent before providing service and billing (example agreement language provided)
If a necessary Healthy Connections referral is missing, the service is considered non-covered and provider/participant may agree to a private pay arrangement
Denial for covered service — participant billing not allowed when: (1) third-party liable; (2) billing error — resubmit corrected claim; (3) billing submitted > 1 year after service (no earlier timely filing referenced)

Billing Rule

Separate billing by date-of-service for July 1, 2014 rate changes

Bill services with dates of service before July 1, 2014 separately from services on or after July 1, 2014 to ensure correct reimbursement under the new rates effective July 1, 2014.

Failure to separate date-segmented billing may result in payment errors
New code-specific rates (e.g., G9001, G9002, T1001, T1002, T1003, S5125, S5130) apply beginning July 1, 2014

Prior Authorization

Prior authorization sources and how to check status

PA request forms with 'fax to' numbers available at www.idmedicaid.com under Forms (DHW Forms heading)
MCU does not give authorizations over the telephone
To check authorization status: Trading Partner Account → Form Entry → Authorization Status; or call Molina 1 (866) 686-4272, option 3 for assistance

Note

Directory: Healthy Connections and Qualis Health contacts

Qualis Health toll number: 1 (800) 783-9207
Qualis Health web resource: http://www.qualishealth.org/healthcare-professionals/idaho-medicaid
Fax contact listed for regional coordinators: 1 (208) 334-2026 (as shown in directory)

Note

Regional coordinator phone numbers and web link

Region phone listings include local and toll-free numbers (e.g., 1 (208) 666-6766; toll-free 1 (800) 299-6766)
Qualis Health web resource: http://www.qualishealth.org/healthcare-professionals/idaho-medicaid

Note

Regional contact directory (Regions I–IV)

Consult the regional contact directory for phone listings of Healthy Connections Regional Health Resource Coordinators (Regions I–IV) that include both local and toll-free numbers for provider use.

Region I (Coeur d'Alene): 1 (208) 666-6766; toll-free 1 (800) 299-6766
Region II (Lewiston): 1 (208) 799-5088; toll-free 1 (800) 799-5088
Region III (Caldwell): 1 (208) 455-7244; additional contact 1 (208) 642-7006
Region IV (Boise): 1 (208) 334-0717

Note

Regional contact list by office

Region IV (Boise) additional number shown: 1 (208) 334-0718
Toll-free contact repeats for several regions (e.g., 1 (800) 299-6766)

Documentation Required

Molina Provider and Participant Services contact details

Provider Services MACS: 1 (866) 686-4272; Provider Service Representatives: 1 (208) 373-1424 or 1 (866) 686-4272 (Mon–Fri, 7 a.m.–7 p.m. MT)
Participant Services MACS: 1 (866) 686-4752 or 1 (208) 373-1432 (Mon–Fri, 7 a.m.–7 p.m. MT)
Email for provider services: idproviderservices@molinahealthcare.com; mailing addresses for claims and utilization management shown in directory

Documentation Required

Provider services fax numbers

Use designated fax numbers for Provider Enrollment and Provider and Participant Services when submitting documents or correspondence.

Provider Enrollment fax: 1 (877) 517-2041
Provider and Participant Services fax: 1 (877) 661-0974

Note

Region 3 (Caldwell) contact

For Region 3 matters (including Oregon), contact Rainy Natal at the Caldwell office listing: 3402 Franklin, Caldwell, ID 83605; phone 1 (208) 860-4682; email Region.3@MolinaHealthCare.com.

Office address: 3402 Franklin, Caldwell, ID 83605
Phone: 1 (208) 860-4682
Email: Region.3@MolinaHealthCare.com

Note

Region 4 (Boise) contact

For Region 4 and all other states, contact Robert Hughes at the Boise office: 1720 Westgate Drive, Suite A, Boise, ID 83704; phone 1 (208) 373-1343; email Region.4@MolinaHealthCare.com.

Office address: 1720 Westgate Drive, Suite A, Boise, ID 83704
Phone: 1 (208) 373-1343
Email: Region.4@MolinaHealthCare.com

Note

Region 5 (Twin Falls) contact

For Region 5 (and Nevada), contact Brenda Rasmussen at 803 Harrison St., Twin Falls, ID 83301; phone 1 (208) 484-6323; email Region.5@MolinaHealthCare.com.

Office address: 803 Harrison St., Twin Falls, ID 83301
Phone: 1 (208) 484-6323
Email: Region.5@MolinaHealthCare.com

Note

Region 6 (Pocatello) contact

For Region 6 (and Utah), contact Kelsey Gudmunson at 1070 Hiline Road, Pocatello, ID 83201; phone 1 (208) 870-3997; email Region.6@MolinaHealthCare.com.

Office address: 1070 Hiline Road, Pocatello, ID 83201
Phone: 1 (208) 870-3997
Email: Region.6@MolinaHealthCare.com

Note

Region 7 (Idaho Falls) contact

For Region 7 (and Wyoming), contact Kristi Harris at 150 Shoup Avenue, Idaho Falls, ID 83402; phone 1 (208) 991-7149; email Region.7@MolinaHealthCare.com.

Office address: 150 Shoup Avenue, Idaho Falls, ID 83402
Phone: 1 (208) 991-7149
Email: Region.7@MolinaHealthCare.com
Molina mailing address: PO Box 70082, Boise, Idaho 83707