certified family home training - idmedicaid.com documentation/certified famil… · certified...

Idaho Department of Health & Welfare

Certified Family Home Training


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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Navigating the Secure Portal

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Navigating the Secure Portal

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Prior Authorization

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View Authorization

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Note: Authorizations are issued by DHW.


View Authorization

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View Authorization

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Patient Roster

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View Patient Roster

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View Patient Roster

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View Patient Roster

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Eligibility

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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.


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


Patient Roster | Verify Eligibility

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Eligibility | A&D Waiver Coverage

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Eligibility | DD Waiver Coverage

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Eligibility | Enhanced Coverage

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Eligibility | Medicare Medicaid Coordinated Plan (MMCP)

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Eligibility | Idaho Medicaid Plus (IMPlus)

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Claim Submission

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Patient Roster | Submit Claim

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Claim Submission | Professional Claim (1500)

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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.)


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.


View Claim Status

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View Claim Status

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Search Criteria

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Remittance Advice

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Viewing RAs

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RA Banner Page

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RA Detail

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RA Summary Page

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Provider Relations Consultants

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Region 1 and the state of [email protected]



Region 4 and all other states [email protected]




mailto:[email protected]








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.

certified family home training - idmedicaid.com documentation/certified famil… · certified...

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