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OPPORTUNITY FOR REVERSAL OF CLAIM RECOUPMENT
Retrospective post payment Medical Necessity and DRG validation cases previously technically denied for not submitting medical records are now eligible to be reopened for review. Reopening Technically Denied Cases
APR DRG Updates: Effective 10/1/2024
Acute Care Hospitals will be subject to updates to the 3MTM All Patient Refined DRG (3M APR DRG) Software reimbursement methodology effective October 1, 2024. This update will result in changes to base rates, and policy adjusters. This change will not affect...
New Idaho Behavioral Health Plan launching July 1st, 2024.
New Idaho Behavioral Health Plan launching July 1st, 2024. Telligen will no longer do reviews for inpatient psychiatric hospital stays or pediatric residential treatment facilities. Launch Plan
Attention Idaho Medicaid CHIS Providers
Provider Memo: Attention Idaho Medicaid CHIS Providers: You will no longer be prompted to enter MCG Guideline Documentation when submitting requests. You will now see this and all you need to do is click on the orange “Submit Request” button
Website for Posting YES Class Complaints
If you are a YES Class member and would like the opportunity to file a complaint anonymously with the YES program team, click here.