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Important DME Submission Update

Provider Memo: RE: DME prior authorization requests To expedite the manual pricing process, Idaho Medicaid and the Medical Care Unit are requesting a change in how the DME requests are built and approved. Effective Immediately: All manually priced miscellaneous (MISC)...

All DME Prior Authorization Reviews Now Completed by Telligen

On January 1st, 2022, Telligen began reviewing DME prior authorization requests. All DME prior authorization requests must be submitted to Telligen via the online Qualitrac portal (preferred method) or via secure fax to (866) 539-0365. Portal access is easy and...

Upcoming Post Payment Audit

On July 1, 2021, IDHW moved to the APR-DRG reimbursement model and discontinued the prospective review of certain inpatient stays conducted by UM vendor, Telligen. Due to that change, IDHW will be implementing a monthly post payment audit process. As a part of the...

Case Management Self-Referral for Enrollees

Providers: Please take note of this announcement and direct members to it at your discretion. **ATTENTION MEDICAID MEMBERS** If you or Medicaid members in your family have one of the following conditions, or are accessing one of the following services, you may be...

Important Announcement on Prior Auth & Acute Rehab Level of Care

Effective immediately: Prior authorization for the Acute Rehabilitation level of care is no longer required for APR-DRG facilities. As part of this update, prior authorization, concurrent, and continued stay review authorization requirements are no longer required for...

DRG Implementation

Acute Care Hospitals will be subject to changes in their reimbursement methodology effective July 1, 2021. Acute Care Hospitals will be reimbursed using 3MTM All Patient Refined DRG (APR DRG) Software. This change does not affect in-state Critical Access hospitals,...

Portal Registration Just Got Easier

Telligen is pleased to announce a simplified process for registration to our Qualitrac portal. Effective immediately, all new portal registrations will be completed entirely online. Simply click on the Provider Portal Registration link and follow the online...

ASAM 3.7

To provide Medicaid reimbursed American Society of Addiction Medicine (ASAM) based Medically Managed Intensive Inpatient, ASAM 4.0 or Medically Monitored Intensive Inpatient, ASAM 3.7, you must fall into one of the following provider types: An IMD that is licensed,...

IDT Code Now Live!

Good news! The new Interdisciplinary Training code (IDT) is now live in our system.  What does that mean for you? For new IDT requests -  please start requesting IDT through Qualitrac with the new, updated code of H2019 HT. Remember that this is a 15-minute code, so...