Certified Family Home Training - idmedicaid.com Documentation/Certified Famil… · Certified...

Idaho Department of Health & Welfare

Certified Family Home Training

Idaho Department of Health & Welfare

Overview

• Trading Partner Account registration and sign-in

• Prior Authorization

• Patient Roster

o Eligibility

o Claim Submission

▪ Copy Last Claim

• Claim Status

• Remittance Advice

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Idaho Department of Health & Welfare

Navigating the Secure Portal

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Idaho Department of Health & Welfare

Navigating the Secure Portal

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Idaho Department of Health & Welfare

Prior Authorization

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Idaho Department of Health & Welfare

View Authorization

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Note: Authorizations are issued by DHW.

Idaho Department of Health & Welfare

View Authorization

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Idaho Department of Health & Welfare

View Authorization

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Idaho Department of Health & Welfare

Patient Roster

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Idaho Department of Health & Welfare

View Patient Roster

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Idaho Department of Health & Welfare

View Patient Roster

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Idaho Department of Health & Welfare

View Patient Roster

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Idaho Department of Health & Welfare

Eligibility

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Idaho Department of Health & Welfare

Participant Eligibility

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Why should you verify eligibility?

• To verify a participant has Medicaid coverage on actual date of service

• To review a participant’s eligibility plan, coverage codes, and healthy connections provider

Note: Medicaid card does not guarantee current Medicaid coverage.

Idaho Department of Health & Welfare

Verifying Eligibility

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Three ways to verify eligibility:

• MACS — Medicaid Automated Customer Service 1(866)686-4272

• HIPAA compliant vendor software• Health PAS-OnLine Trading Partner

To obtain eligibility information from one of these systems, submit two pieces of identifying information from the following list:

• Medicaid ID number (ten digits)• Social Security Number (SSN) • Last Name, First Name • Date of Birth

Idaho Department of Health & Welfare

Patient Roster | Verify Eligibility

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Idaho Department of Health & Welfare

Eligibility | A&D Waiver Coverage

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Idaho Department of Health & Welfare

Eligibility | DD Waiver Coverage

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Idaho Department of Health & Welfare

Eligibility | Enhanced Coverage

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Idaho Department of Health & Welfare

Eligibility | Medicare Medicaid Coordinated Plan (MMCP)

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Idaho Department of Health & Welfare

Eligibility | Idaho Medicaid Plus (IMPlus)

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Idaho Department of Health & Welfare

Claim Submission

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Idaho Department of Health & Welfare

Patient Roster | Submit Claim

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Idaho Department of Health & Welfare

Claim Submission | Professional Claim (1500)

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Idaho Department of Health & Welfare

Claim Submission | Confirmation

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• The claim ID displays in the upper left corner of the confirmation page.

• Select Adjudicate Claim to identify outstanding edits.

• Select the Edit Claim button to modify this claim.

(For example, if you realize the dates of service are incorrect, you can immediately fix the claim.)

Idaho Department of Health & Welfare

Claim Submission | Copy Last Claim

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Copy Last Claim will copy over some information from the last claim submitted for this participant. However, it is important to review all fields to either add additional or correct pre-populated information.

Idaho Department of Health & Welfare

View Claim Status

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Idaho Department of Health & Welfare

View Claim Status

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Idaho Department of Health & Welfare

Search Criteria

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Idaho Department of Health & Welfare

Remittance Advice

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Idaho Department of Health & Welfare

Viewing RAs

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Idaho Department of Health & Welfare

RA Banner Page

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Idaho Department of Health & Welfare

RA Detail

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Idaho Department of Health & Welfare

RA Summary Page

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Idaho Department of Health & Welfare

Provider Relations Consultants

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Region 1 and the state of WashingtonRegion.1@DXC.Com

Region 2 and the state of MontanaRegion.2@DXC.Com

Region 3 and the state of OregonRegion.3@DXC.Com

Region 4 and all other states Region.4@DXC.Com

Region 5 and the state of NevadaRegion.5@DXC.Com

Region 6 and the state of UtahRegion.6@DXC.Com

Region 7 and the state of WyomingRegion.7@DXC.Com

Idaho Department of Health & Welfare

Thank you for attending our Certified Family Home

Training.

Please take a few minutes to complete the survey that will be emailed following this presentation. This

provides us with valuable information for future trainings.