CurrentIdaho Department of Health and WelfarePolicy N/A

Once in a Lifetime Procedures and Modifiers

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Defines Idaho Medicaid reimbursement rules for procedures that are reimbursed only once during a patient's lifetime and describes applicable procedural and anatomical modifiers required for claim adjudication. Affects providers billing Idaho Medicaid.

Policy Summary

PayerIdaho Department of Health and Welfare

PolicyOnce in a Lifetime Procedures and Modifiers

Policy CodePolicy N/A

Change TypeNo material change

Effective DateN/A

Next Review DateN/A

Key ActionUse required anatomical modifiers (e.g., RT, LT, E1–E4) when applicable; claims without applicable anatomical modifiers are considered incomplete.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

1procedures reimbursed per Code Family

4example codes in appendectomy family

3anatomical modifier groups documented

2billing/process tips

Coverage and Reimbursement Rules

Once in a Lifetime reimbursement criteria

Idaho Medicaid reimburses specified procedures only once per patient lifetime from a designated Code Family; limited exceptions and modifier rules apply.

EXCEPTION — Multiple submissions considered separately when reported with one of the following procedural modifiers:

Modifier 53 — Discontinued procedure
Modifier 55 — Postoperative management only
Modifier 56 — Preoperative management only
Modifier 58 — Staged or related procedure or service by the same physician

Anatomical modifiers (for example RT and LT; and site-specific modifiers such as eyelid modifiers E1–E4) must be used when applicable; Medicaid considers a claim incomplete without an applicable anatomical modifier.

Example: Appendectomy Code Family: only a single code from this family (e.g., 44950, 44955, 44960, 44970) will be reimbursed once in a lifetime, unless an allowed procedural modifier is appended.

Infant formula coverage criteria

Infant formula coverage rules referenced in the bulletin.

Traditional retail infant formula that is orally fed is not considered medically necessary and is not covered; tube-fed traditional infant formula is considered for coverage.

ALL of the following

Prescribed by a physician
Labeled solely for dietary management of specific clinically serious or life‑threatening diseases or conditions
Generally required for a prolonged period of time

Providers seeking coverage for medical-grade formulas must follow DME prior authorization procedures and refer to the Suppliers Idaho MMIS Provider Handbook (see the 'Oral, Enteral, or Parenteral Nutritional Products, Equipment, and Supplies' section) for authorization details.

Documentation requirements

Documentation and record retention requirements impacting coverage and payment.

Providers must generate documentation at the time of service sufficient to support each claim; documentation must be legible, consistent with professionally recognized standards, and retained for five (5) years from the date the item or service was provided.

Documentation to support claims includes, but is not limited to: medical records, treatment plans, medical necessity justification, assessments, appointment sheets, patient accounts, and financial records, regardless of form or media.

Claims billed without documentation that meets rule requirements will be subject to recoupment and civil monetary penalties.

Rolling 30-day limits policy

Change in calculation of monthly limits for services with calendar month/unit limits.

Effective July 1, 2017, calendar month limits change to rolling 30-day limits counted by service (dispense) date; unit limits remain unchanged but are evaluated within a 30-day window (30 days forward and back from the service date).

Developmental Disabilities provider types are exempt from this change and will remain on calendar month limits.

The MMIS pays claims in the order they are received; when multiple providers submit claims for the same service within the rolling 30-day window, the system may pay earlier claims first and later claims can be denied if units are exhausted.

Scenarios (illustrative): Examples in the bulletin show how sequential claims within 30 days can exhaust allowed units and cause later claims to be denied based on the rolling-window calculation.

Physician Self-Referral (Stark) stance

Stark (Physician Self‑Referral) restrictions and enforcement posture.

Physicians may not refer Medicare/Medicaid patients for designated health services to entities with which the physician or an immediate family member has a financial relationship, unless an exception applies.

Financial relationships include ownership/investment interests and compensation arrangements.

Designated health services include: clinical laboratory; PT/OT/SLP; radiology and certain imaging; radiation therapy; DME and supplies; parenteral/enteral nutrients, equipment and supplies; prosthetics/orthotics; home health; outpatient prescription drugs; and inpatient/outpatient hospital services.

Prior authorization and medical review

Prior authorization (PA) and Medical Care Unit (MCU) medical review processes and contacts.

Providers must use the Medical Care Unit website (www.medunit.dhw.idaho.gov) and idmedicaid.com to obtain PA requirements and request forms; MCU will not authorize services by telephone or for services that do not require PA.

Prior authorization request forms (with fax numbers) are available on www.idmedicaid.com under Forms → DHW Forms; PA requests must be complete and include required documentation or they may be denied and must be resubmitted.

For questions about MCU medical review decisions, contact the listed MCU phone/fax numbers by service area or e-mail MedicalCareUnit@dhw.idaho.gov.

Codes, Modifiers, and Mappings

Appendectomy Code Family (example)CPTCovered

44950	Appendectomy
44955	Appendectomy; when done for indicated purpose at time of other major procedure
44960	Appendectomy; for ruptured appendix with abscess or generalized peritonitis
44970	Laparoscopy, surgical, appendectomy

Eyelid modifiers mappingModifier

E1	Eyelid anatomical modifier mapped to various eyelid location codes (examples: many mapped to E4 or blank as listed).
E4	Eyelid modifier referenced as target mapping for many E1 entries.

Coronary artery modifiersModifier

LC	Left circumflex coronary artery
LD	Left anterior descending coronary artery
LM	Left main coronary artery
RC	Right coronary artery
RI	Ramus intermedius coronary artery

Finger modifiersModifier

FA-F9

Finger anatomical modifiers identifying digits on left and right hand (FA left thumb through F9 right fifth digit).

Toe modifiersModifier

TA-T9

Toe anatomical modifiers identifying toes on left and right foot (TA left great toe through T9 right fifth toe).

Stark law designated health servicesmixed

Designated health services (list)

Clinical laboratory; physical therapy, occupational therapy, and outpatient speech-language pathology services; radiology and certain other imaging services; radiation therapy services and supplies; DME and supplies; parenteral and enteral nutrients, equipment, and supplies; prosthetics, orthotics, and prosthetic devices and supplies; home health services; outpatient prescription drugs; inpatient and outpatient hospital services.

Billing Steps, Prior Authorization, and Contacts

Billing Rule

Use listed procedural modifiers to permit separate reimbursement

If a Once in a Lifetime Procedure must be submitted more than once during a patient's lifetime, report the procedure with one of the listed procedural modifiers (53, 55, 56, or 58) so each submission will be considered separately for reimbursement.

Allowed modifiers: 53 (Discontinued procedure); 55 (Postoperative management only); 56 (Preoperative management only); 58 (Staged or related procedure or service by the same physician)

Documentation Required

Append anatomical modifiers (RT/LT etc.) when applicable

Use anatomical modifiers when applicable; Medicaid considers a claim incomplete without an anatomical modifier if one applies to the service.

Common side modifiers: RT (Right side) and LT (Left side) — must be used when applicable.

Documentation Required

Confirm Trading Partner Account reversals/adjustments via confirmation message

When reversing or adjusting a claim in a Trading Partner Account, select the appropriate option on the Reverse Claim Tab and confirm the action is complete by viewing the confirmation message.

Verify completion by viewing the system-generated confirmation message before exiting the reversal workflow.

Billing Rule

Select the appropriate reverse-claim option (adjust vs. reverse only)

Choose the correct reversal workflow: reverse and create a new claim (adjust and resubmit) or reverse only; each produces a different confirmation and has different follow-up options.

Option 1 — Reverse and create a new claim: correct and resubmit; confirmation shows original claim number followed by A# (e.g., A1).
Option 2 — Reverse only: returns paid funds; confirmation shows original claim number followed by R1; no further adjustments allowed.

Prior Authorization

Provide complete documentation with prior authorization requests

Submit complete, valid prior authorization requests with all required documentation; incomplete or missing documentation can prevent review and result in denial and a required resubmission.

Use the new DME PA request form for services starting May 1, 2017 when applicable.
Check the Suppliers Idaho MMIS Provider Handbook and IDAPA 16.03.09.750-779 for documentation requirements.
Items requiring PA are listed on the current fee schedule — verify before submitting.

Documentation Required

Locate PA forms and guidance on MCU and idmedicaid.com

Find prior authorization request forms and PA requirement guidance on the Medical Care Unit webpage and on idmedicaid.com; MCU does not authorize services by telephone.

Medical Care Unit webpage: www.medunit.dhw.idaho.gov
PA request forms with fax‑to numbers: www.idmedicaid.com → References → Forms → DHW Forms
Mailing address for PA forms: Medicaid Medical Care Unit, P.O. Box 83720, Boise, ID 83720-0009

Documentation Required

Verify PA status via Trading Partner Account; contact Molina for denial reasons

Check prior authorization status through your Trading Partner Account on www.idmedicaid.com; if the reason for denial is unclear, Molina Medicaid Solutions can provide the medical reviewer's reason captured in non-clinical notes.

Log in to Trading Partner Account → Form Entry → Authorization Status to view PA status.
For assistance or to speak with a Molina representative call 1 (866) 686-4272, option 3.

Note

Contact Healthy Connections Regional Health Resource Coordinators for assistance

Contact Healthy Connections Regional Health Resource Coordinators for assistance; phone and fax numbers are provided for regional offices including Region I (Coeur d'Alene).

Region I (Coeur d'Alene) phone: 1 (208) 666-6766; toll-free: 1 (800) 299-6766
General fax: 1 (866) 539-0365
Website: http://IDMedicaid.Telligen.com

Note

Call regional Healthy Connections coordinators (Regions I–IV)

Providers may contact regional Healthy Connections coordinators for assistance; phone numbers are listed for Regions I–IV.

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

Documentation Required

Use listed phone numbers to reach DHW Healthy Connections region staff

For region-specific assistance, contact the DHW Healthy Connections Regional Health Resource Coordinators using the phone numbers provided for each region.

Region I (Coeur d'Alene): 1 (208) 666-6766 or 1 (800) 299-6766
Region II (Lewiston): 1 (208) 799-5088 or 1 (800) 799-5088
Region III (Caldwell): 1 (208) 455-7244, 1 (208) 642-7006, or 1 (800) 494-4133
Region IV (Boise): 1 (208) 334-0717; additional Boise number: 1 (208) 334-0718

Note

Regional DHW Healthy Connections phone numbers for Regions I–IV

The bulletin provides phone contact numbers for DHW Healthy Connections Regional Health Resource Coordinators for Regions I–IV; use these numbers to request assistance.

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; 1 (208) 642-7006; 1 (800) 494-4133
Region IV (Boise): 1 (208) 334-0717; 1 (208) 334-0718

Note

Insurance verification contact (HMS)

For insurance verification, contact HMS at 1 (800) 873-5875; mailing address PO Box 2894, Boise, ID 83701; fax 1 (208) 375-1134.

HMS phone: 1 (800) 873-5875
Mail: PO Box 2894, Boise, ID 83701
Fax: 1 (208) 375-1134

Note

Molina Provider Services and Participant Services contact information

Use Molina Provider Services or Participant Services for assistance with authorizations, claims, and Trading Partner Account issues; contact numbers, email addresses, and mailing addresses are provided.

Provider Services MACS phone: 1 (866) 686-4272; local: 1 (208) 373-1424
Participant Services MACS phone: 1 (866) 686-4752; local: 1 (208) 373-1432
Provider Services email: idproviderservices@molinahealthcare.com; Provider Enrollment email: idproviderenrollment@molinahealthcare.com
Provider Enrollment fax: 1 (877) 517-2041; Provider and Participant Services fax: 1 (877) 661-0974
Mailing addresses: P.O. Box 70082 / 70084 / 70081 as listed for specific functions in the bulletin

Key Terms and Definitions

Once in a Lifetime Procedures — definition and scope (Code Family reimbursement rule)

ExampleAppendectomy Code Family (CPT 44950, 44955, 44960, 44970) — only one code from this family will be reimbursed per lifetime.

Claim handlingIf any code from the designated Code Family is reported, Medicaid treats that code and any code from the same Code Family as subject to the once-in-a-lifetime reimbursement limit.

Modifier — definition of a modifier and its role

DefinitionA modifier is a code appended to a procedure code to add information or change the description of a service to improve accuracy or specificity of the billed procedure.

PurposeUsed to more accurately represent the service or item rendered in documentation and on claims.

Provider responsibilityProviders must accurately, completely, and legibly document services and use modifiers when appropriate.

Anatomical modifier — definition and examples (RT/LT, eyelid modifiers)

DefinitionAn anatomical modifier designates the area or part of the body on which the procedure is performed to assist in prompt, accurate adjudication of claims.

Common modifiersRT (Right side) and LT (Left side) — must be used when applicable.

Policy noteMedicaid considers a claim incomplete without an applicable anatomical modifier.

Coronary artery modifiers (LC, LD, LM, RC, RI) — definition entry

DefinitionCoronary artery modifiers identify the coronary artery on which a procedure or service was performed during a single session.

ExamplesLC — Left circumflex coronary artery; LD — Left anterior descending coronary artery; LM — Left main coronary artery; RC — Right coronary artery; RI — Ramus intermedius coronary artery.

UseAppend the appropriate coronary artery modifier to indicate the precise site for coronary procedures performed in a single session.

Finger modifiers (FA-F9) — definition entry

DefinitionFinger modifiers (FA–F9) are anatomical modifiers that identify the finger on which a procedure or service was performed at a single session.

MappingFA — Left hand, thumb; F1–F4 — left hand second through fifth digits; F5 — right hand, thumb; F6–F9 — right hand second through fifth digits.

PurposeUse to specify the exact digit treated so claims accurately reflect laterality and digit-specific services.

Toe modifiers (TA-T9) — definition entry

DefinitionToe modifiers (TA–T9) are anatomical modifiers that identify the toe on which a procedure or service was performed at a single session.

MappingTA — Left foot, great toe; T1–T4 — left foot second through fifth toes; corresponding T5–T9 denote the right foot great toe through right fifth toe.

PurposeUse to indicate the exact toe treated so claims reflect correct laterality and toe-specific services.

Designated health services — Stark law designated categories definition

DefinitionDesignated health services are specific categories of services covered by Medicare/Medicaid that are subject to physician self-referral (Stark) restrictions.

Categories includedClinical laboratory; PT/OT/SLP; radiology and certain imaging; radiation therapy; durable medical equipment and supplies; parenteral/enteral nutrients, equipment and supplies; prosthetics/orthotics; home health; outpatient prescription drugs; inpatient and outpatient hospital services.

RelevanceReferrals for these services from physicians with a financial relationship to the furnishing entity are prohibited unless an exception applies.

Strict liability (Stark law) — legal standard definition

DefinitionStrict liability under the Stark law means that proof of specific intent to violate the law is not required for enforcement.

ConsequencesPenalties include fines and exclusion from participation in Federal health care programs.

Financial relationship — definition for Stark law contexts

DefinitionA financial relationship is an ownership/investment interest or a compensation arrangement between a physician (or immediate family member) and an entity that furnishes designated health services.

ExamplesOwnership/investment interests and compensation arrangements that may trigger Stark law restrictions if referrals are made to the related entity.

EffectSuch relationships must fit within a Stark exception or referrals/billing for referred services are prohibited.

Regional Health Resource Coordinators — role/label definition

RoleRegional Health Resource Coordinators (Healthy Connections) are DHW regional contacts who assist providers and stakeholders with resources and questions.

CoverageCoordinators cover multiple regions (e.g., Region I Coeur d'Alene, Region II Lewiston, Region III Caldwell), providing phone and fax contact information.

AccessProviders should contact their regional Healthy Connections coordinator for assistance with regional inquiries and resources.

Healthy Connections Regional Health Resource Coordinators — definition and role

DefinitionHealthy Connections Regional Health Resource Coordinators are regional DHW contacts who can assist providers and stakeholders with region-specific resources and inquiries.

Contact methodContact via the phone numbers and web resources (http://IDMedicaid.Telligen.com) listed for each region.

Regional Coordinators — repeated definition entry for Healthy Connections coordinators

DefinitionRegional Coordinators (Healthy Connections Regional Health Resource Coordinators) are DHW regional contacts for provider and public inquiries.

FunctionProvide region-specific assistance and act as a resource for providers seeking local DHW support.

Contact infoPhone numbers for Regions I–IV are listed in the document for direct contact.

Healthy Connections Regional Health Resource Coordinators — additional definition entry

DefinitionHealthy Connections Regional Health Resource Coordinators are DHW regional contacts who provide assistance to providers and stakeholders for region-specific matters.

Web resourceID Medicaid/Telligen website (http://IDMedicaid.Telligen.com) is referenced for region resources.

Healthy Connections regional contacts — compiled contact listing for Regions I–IV

FaxGeneral fax provided in regional resource section: 1 (866) 539-0365.

WebReference site: http://IDMedicaid.Telligen.com for regional information and resources.

Provider Relations Consultants (PRC) — PRC office addresses and phone numbers for Regions 1–7

OverviewProvider Relations Consultants (PRC) offices with addresses and phone numbers are listed for Regions 1–7 to support provider relations and regional coordination.

Region 41720 Westgate Drive, Suite A, Boise, ID 83704 — Phone: 1 (208) 373-1343; email: Region.4@MolinaHealthCare.com.

Policy Summary

PayerIdaho Department of Health and Welfare

PolicyOnce in a Lifetime Procedures and Modifiers

Policy CodePolicy N/A

Change TypeNo material change

Effective DateN/A

Next Review DateN/A

Key ActionUse required anatomical modifiers (e.g., RT, LT, E1–E4) when applicable; claims without applicable anatomical modifiers are considered incomplete.

SourceLink

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Once in a Lifetime Procedures and Modifiers

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 Reimbursement Rules

Once in a Lifetime reimbursement criteria

Idaho Medicaid reimburses specified procedures only once per patient lifetime from a designated Code Family; limited exceptions and modifier rules apply.

EXCEPTION — Multiple submissions considered separately when reported with one of the following procedural modifiers:

Modifier 53 — Discontinued procedure
Modifier 55 — Postoperative management only
Modifier 56 — Preoperative management only
Modifier 58 — Staged or related procedure or service by the same physician

Example: Appendectomy Code Family: only a single code from this family (e.g., 44950, 44955, 44960, 44970) will be reimbursed once in a lifetime, unless an allowed procedural modifier is appended.

Infant formula coverage criteria

Infant formula coverage rules referenced in the bulletin.

Traditional retail infant formula that is orally fed is not considered medically necessary and is not covered; tube-fed traditional infant formula is considered for coverage.

ALL of the following

Prescribed by a physician
Labeled solely for dietary management of specific clinically serious or life‑threatening diseases or conditions
Generally required for a prolonged period of time

Documentation requirements

Documentation and record retention requirements impacting coverage and payment.

Claims billed without documentation that meets rule requirements will be subject to recoupment and civil monetary penalties.

Rolling 30-day limits policy

Change in calculation of monthly limits for services with calendar month/unit limits.

Developmental Disabilities provider types are exempt from this change and will remain on calendar month limits.

Scenarios (illustrative): Examples in the bulletin show how sequential claims within 30 days can exhaust allowed units and cause later claims to be denied based on the rolling-window calculation.

Physician Self-Referral (Stark) stance

Stark (Physician Self‑Referral) restrictions and enforcement posture.

Financial relationships include ownership/investment interests and compensation arrangements.

Prior authorization and medical review

Prior authorization (PA) and Medical Care Unit (MCU) medical review processes and contacts.

For questions about MCU medical review decisions, contact the listed MCU phone/fax numbers by service area or e-mail MedicalCareUnit@dhw.idaho.gov.

Codes, Modifiers, and Mappings

Appendectomy Code Family (example)CPTCovered

44950	Appendectomy
44955	Appendectomy; when done for indicated purpose at time of other major procedure
44960	Appendectomy; for ruptured appendix with abscess or generalized peritonitis
44970	Laparoscopy, surgical, appendectomy

Eyelid modifiers mappingModifier

E1	Eyelid anatomical modifier mapped to various eyelid location codes (examples: many mapped to E4 or blank as listed).
E4	Eyelid modifier referenced as target mapping for many E1 entries.

Coronary artery modifiersModifier

LC	Left circumflex coronary artery
LD	Left anterior descending coronary artery
LM	Left main coronary artery
RC	Right coronary artery
RI	Ramus intermedius coronary artery

Finger modifiersModifier

FA-F9

Finger anatomical modifiers identifying digits on left and right hand (FA left thumb through F9 right fifth digit).

Toe modifiersModifier

TA-T9

Toe anatomical modifiers identifying toes on left and right foot (TA left great toe through T9 right fifth toe).

Stark law designated health servicesmixed

Designated health services (list)

Billing Steps, Prior Authorization, and Contacts

Billing Rule

Use listed procedural modifiers to permit separate reimbursement

Allowed modifiers: 53 (Discontinued procedure); 55 (Postoperative management only); 56 (Preoperative management only); 58 (Staged or related procedure or service by the same physician)

Documentation Required

Append anatomical modifiers (RT/LT etc.) when applicable

Use anatomical modifiers when applicable; Medicaid considers a claim incomplete without an anatomical modifier if one applies to the service.

Common side modifiers: RT (Right side) and LT (Left side) — must be used when applicable.

Documentation Required

Confirm Trading Partner Account reversals/adjustments via confirmation message

When reversing or adjusting a claim in a Trading Partner Account, select the appropriate option on the Reverse Claim Tab and confirm the action is complete by viewing the confirmation message.

Verify completion by viewing the system-generated confirmation message before exiting the reversal workflow.

Billing Rule

Select the appropriate reverse-claim option (adjust vs. reverse only)

Choose the correct reversal workflow: reverse and create a new claim (adjust and resubmit) or reverse only; each produces a different confirmation and has different follow-up options.

Option 1 — Reverse and create a new claim: correct and resubmit; confirmation shows original claim number followed by A# (e.g., A1).
Option 2 — Reverse only: returns paid funds; confirmation shows original claim number followed by R1; no further adjustments allowed.

Prior Authorization

Provide complete documentation with prior authorization requests

Submit complete, valid prior authorization requests with all required documentation; incomplete or missing documentation can prevent review and result in denial and a required resubmission.

Use the new DME PA request form for services starting May 1, 2017 when applicable.
Check the Suppliers Idaho MMIS Provider Handbook and IDAPA 16.03.09.750-779 for documentation requirements.
Items requiring PA are listed on the current fee schedule — verify before submitting.

Documentation Required

Locate PA forms and guidance on MCU and idmedicaid.com

Find prior authorization request forms and PA requirement guidance on the Medical Care Unit webpage and on idmedicaid.com; MCU does not authorize services by telephone.

Medical Care Unit webpage: www.medunit.dhw.idaho.gov
PA request forms with fax‑to numbers: www.idmedicaid.com → References → Forms → DHW Forms
Mailing address for PA forms: Medicaid Medical Care Unit, P.O. Box 83720, Boise, ID 83720-0009

Documentation Required

Verify PA status via Trading Partner Account; contact Molina for denial reasons

Log in to Trading Partner Account → Form Entry → Authorization Status to view PA status.
For assistance or to speak with a Molina representative call 1 (866) 686-4272, option 3.

Note

Contact Healthy Connections Regional Health Resource Coordinators for assistance

Contact Healthy Connections Regional Health Resource Coordinators for assistance; phone and fax numbers are provided for regional offices including Region I (Coeur d'Alene).

Region I (Coeur d'Alene) phone: 1 (208) 666-6766; toll-free: 1 (800) 299-6766
General fax: 1 (866) 539-0365
Website: http://IDMedicaid.Telligen.com

Note

Call regional Healthy Connections coordinators (Regions I–IV)

Providers may contact regional Healthy Connections coordinators for assistance; phone numbers are listed for Regions I–IV.

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

Documentation Required

Use listed phone numbers to reach DHW Healthy Connections region staff

For region-specific assistance, contact the DHW Healthy Connections Regional Health Resource Coordinators using the phone numbers provided for each region.

Region I (Coeur d'Alene): 1 (208) 666-6766 or 1 (800) 299-6766
Region II (Lewiston): 1 (208) 799-5088 or 1 (800) 799-5088
Region III (Caldwell): 1 (208) 455-7244, 1 (208) 642-7006, or 1 (800) 494-4133
Region IV (Boise): 1 (208) 334-0717; additional Boise number: 1 (208) 334-0718

Note

Regional DHW Healthy Connections phone numbers for Regions I–IV

The bulletin provides phone contact numbers for DHW Healthy Connections Regional Health Resource Coordinators for Regions I–IV; use these numbers to request assistance.

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; 1 (208) 642-7006; 1 (800) 494-4133
Region IV (Boise): 1 (208) 334-0717; 1 (208) 334-0718

Note

Insurance verification contact (HMS)

For insurance verification, contact HMS at 1 (800) 873-5875; mailing address PO Box 2894, Boise, ID 83701; fax 1 (208) 375-1134.

HMS phone: 1 (800) 873-5875
Mail: PO Box 2894, Boise, ID 83701
Fax: 1 (208) 375-1134

Note

Molina Provider Services and Participant Services contact information

Provider Services MACS phone: 1 (866) 686-4272; local: 1 (208) 373-1424
Participant Services MACS phone: 1 (866) 686-4752; local: 1 (208) 373-1432
Provider Services email: idproviderservices@molinahealthcare.com; Provider Enrollment email: idproviderenrollment@molinahealthcare.com
Provider Enrollment fax: 1 (877) 517-2041; Provider and Participant Services fax: 1 (877) 661-0974
Mailing addresses: P.O. Box 70082 / 70084 / 70081 as listed for specific functions in the bulletin