Provider Handbook Directory - Health PAS
Idaho MMIS Directory Table of Contents 1. Section Modifications ............................................................................................ 1 2. Introduction ........................................................................................................ 3 3. Division of Medicaid .............................................................................................. 3 4. Participant Service Numbers .................................................................................. 4 5. Idaho Cities by Medicaid Region ............................................................................. 5 6. Children’s Developmental Disabilities (DD) Program ................................................. 6 7. Healthy Connections (HC) ..................................................................................... 7 8. Prior Authorization (PA) Contacts ........................................................................... 8 9. Regional Medicaid Services (RMS) .......................................................................... 9 10. Third Party Recovery (TPR) and Crossover Claim Contacts ................................... 10 11. Molina Medicaid Solutions ................................................................................ 11 11.1. MACS ...................................................................................................... 11 11.2. Addresses and Phone Numbers ................................................................... 11 11.3. Molina Regional Provider Relations Consultants (PRCs) .................................. 12 December 18, 2014 Page i Idaho MMIS 1. Section Modifications Version 18.0 17.1 17.0 16.1 16.0 15.1 15.0 14.1 14.0 13.1 13.0 12.1 12.0 11.2 11.1 11.0 10.2 10.1 10.0 9.1 9.0 8.1 8.0 7.2 7.1 7.0 6.1 6.0 5.2 5.1 5.0 4.1 4.0 3.3 Directory Section / Column Modification Description Publish Date SME All 5. Idaho Cities by Medicaid Region All 2. Introduction 3. Division of Medicaid 8. Prior Authorization (PA) Contacts All 11.3 Regional Provider Relations Consultants (PRCs) All 11.3 Regional Provider Relations Consultants (PRCs) All 5. Idaho Cities by Medicaid Region Published version Added Driggs to Region 7 12/18/14 12/18/14 Published version Updated contact information 11/24/14 11/24/14 Published version Removed Region 8 09/11/14 09/11/14 TQD C Taylor Published version Updated address for Region 5 09/02/14 09/02/14 TQD C Taylor Published version Removed Council from Region 4 02/21/14 02/21/14 All 11.3 Regional Provider Relations Consultants (PRCs) All 11.2 Addresses and Phone Numbers 4.0 Participant Service Numbers All 11.3 PRCs 8. PA Contacts Published version Updated Region 8 description; added “Molina” to section title. 01/17/14 01/17/14 TQD R Natal D Baker C Taylor TQD D Baker C Taylor Published version Added Claims Review Request Form information Updated numbers for Medicaid NonEmergent Transportation Published version Added region 8 Removed Mental Health and Substance Abuse Published version Added Hauser to Region 1 10/04/13 10/04/13 All 5. Idaho Cities by Medicaid Region All 11.2 Addresses and Phone Numbers All 3. Division of Medicaid 10. Third Party Recovery (TPR) and Crossover Claim Contacts All 11.2 Addresses and Phone Numbers All 11.3 Regional PRCs 11.2 Addresses and Phone Numbers All 11.2 Addresses and Phone Numbers All 8.0 Prior Authorization December 18, 2014 TQD K Irby D Baker TQD A Coppinger C Taylor 08/30/13 08/30/13 08/30/13 TQD D Decrevel C Taylor D Baker C Taylor TQD T Kinzler C Burt 06/24/13 06/24/13 D Baker K Irby Published version Updated PO Boxes 05/13/13 05/13/13 TQD D Decrevel Published version Put information in alpha order Updated information for Part B Medicare 03/14/13 03/14/13 03/14/13 TQD TQD C Taylor Published version Updated Technical Services e-mail address 02/21/13 02/21/13 TQD R Czerny Published version Updated phone number for region four Updated PO Box for UB-04s 09/21/12 09/21/12 09/21/12 TQD D Schiller D Decrevel Published version Removed outdated information 11/23/11 11/23/11 TQD D Decrevel Published version Updated 07/29/11 07/29/11 TQD R Baldwin 10/04/13 Page 1 of 12 Idaho MMIS Version Directory Section / Column 3.1 (PA) Contacts 11.3 Regional Provider Relations Consultants (PRCs) All 3.0 2.0 1.0 All All All 3.2 December 18, 2014 Modification Description Publish Date SME Update PRC Region Information 07/29/11 J Gillet Sections were renumbered to accommodate additional information Published version Published version Initial document – Published version 07/29/11 TQD 03/11/11 08/27/10 05/07/10 TQD TQD TQD Page 2 of 12 Idaho MMIS 2. Directory Introduction The directory contains contacts, addresses, telephone numbers, and fax numbers that providers may need. Providers may get information about the Idaho Medicaid Program on the Internet at the following sites: Idaho Medicaid www.medicaid.idaho.gov/ Idaho Department of Health and Welfare (DHW) www.healthandwelfare.idaho.gov Centers for Medicare and Medicaid Services (CMS) www.cms.gov Qualis Health https://www.qualishealth.org/healthcare-professionals/idaho-medicaid Optum Idaho https://m1.optumidaho.com/web/optumidaho/home Idaho Smiles – DentaQuest https://www.bcidaho.com/about_us/idaho_smiles.asp American Medical Response – Access2Care http://www.idahonemt.net/index.html MMCP Medicare Medicaid Coordinated Plan https://www.bcidaho.com/providers/Policies/HCBSPAP/index_HCBSunsecure.asp 3. Division of Medicaid Appeals Administrative Procedures PTC Building, 10th floor 450 West State Street P.O. Box 83720 Boise, Idaho 83720-0036 1 (208) 334-5564 Fax: 1 (208) 334-6558 December 18, 2014 Bureau of Developmental Disability Services P.O. Box 83720 Boise, Idaho 83720-0009 1 (208) 364-1840 Fax: 1 (208) 332-7286 Estate Recovery P.O. Box 83720 Boise, Idaho 83720-0009 1 (208) 364-1975 1 (866) 849-3843 Fax: 1 (866) 852-2954 Page 3 of 12 Idaho MMIS Bureau of Long-Term Care Directory Medical Care Unit Medicaid Provider Fraud and Program Integrity P.O. Box 83720 Boise, Idaho 83720-0009 1 (208) 364-1968 P.O. Box 83720 Boise, Idaho 83720-0009 1 (208) 364-1974 Fax: 1 (208) 332-7280 P.O. Box 83720 Boise, ID 83720-0036 prvfraud@dhw.idaho.gov 1 (208) 334-5754 Fax: 1 (208) 334-2026 Pharmacy and Medicaid Participant Lock-in Preventive Health Assistance (PHA) Unit Office of Mental Health and Substance Abuse P.O. Box 83720 Boise, Idaho 83720-0009 1 (208) 364-1829 1 (866)-827-9967 Fax: 1 (800) 327-5541 P.O. Box 83720 Boise, Idaho 83720-0009 1 (877) 364-1843 1 (208) 364-1843 Fax: 1 (877) 845-3956 P.O. Box 83720 Boise, Idaho 83720-0009 1 (208) 334-0767 1 (866) 681-7062 Fax: 1 (866) 241-7278 Financial Operations P.O. Box 83720 Boise, Idaho 83720-0009 1 (208) 287-1150 Fax: 1 (208) 287-1170 4. Participant Service Numbers Applications for Children's Health Insurance Program (CHIP) 2-1-1 or 1 (800) 926-2588 (Idaho CareLine) Participant Line (English and Spanish) 1 (866) 686-4752 Fax: 1 (877) 517-2039 Idaho CareLine (English and Spanish) 2-1-1 or 1 (800) 926-2588 Medicaid Non-Emergent Transportation 1 (208) 334-4990 or 1 (877) 503-1261 TTY 1(877) 503-1257 Idaho Nurse Aide Registry 1 (800) 748-2480 December 18, 2014 Page 4 of 12 Idaho MMIS Provider Handbook 5. Directory Idaho Cities by Medicaid Region Region 1: Benewah, Bonner, Boundary, Kootenai, and Shoshone Counties Athol Avery Bayview Blanchard Bonners Ferry Calder Cataldo Clarkfork Clarkia Cocolalla Coeur d’Alene Colburn Careywood Coolin Desmit Dover Eastport Fernwood Harrison Hauser Hayden Lake Hope Kellogg Kingston Kootenai Laclede Medimont Moyie Springs Mullan Murray Naples Nordman Oldtown Osburn Pinehurst Plummer Ponderay Port Hill Post Falls Priest River Rathdrum Sagle Saint Maries Samuals Sandpoint Santa Silverton Smelterville Spirit Lake Tensed Wallace Worley Pierce Pollock Potlach Princeton Riggins Ruebens Southwick Spalding Stites Troy University Viola Weippe White Bird Winchester Weiser Wilder Region 2: Clearwater, Idaho, Latah, Lewis, and Nez Perce Counties Ahsahka Bovill Clearwater Cottonwood Craigmont Culdesac Deary Dixie Elk City Fenn Ferdinand Genesee Grangeville Greencreek Harvard Headquarters Julietta Kamiah Kendrick Keuterville Kooskia Lapwai Lenore Lewiston Lucille Morgan’s Valley Moscow Nez Perce Orofino Peck Region 3: Adams, Canyon, Gem, Owyhee, Payette, and Washington Counties Bruneau Caldwell Cambridge Council Emmett Fruitland Fruitvale Grandview Greenleaf Homedale Huston Indian Valley Letha Marsing Melba Mesa Middleton Midvale Murphy Nampa New Meadows New Plymouth Notus Ola Oreana Owyhee Parma Payette McCall Meridian Montour Mountain Home Northside Pioneerville Placerville Smiths Ferry Star Sweet Warren West Mountain Yellow Pine Region 4: Ada, Boise, Elmore, and Valley Counties Atlanta Banks Boise Cascade Centerville Crouch Donnelly Eagle Featherville Gardena Garden City Garden Valley Glenns Ferry Hammett Horseshoe Bend Idaho City King Hill Kuna Lowman Lakefork Region 5: Blaine, Camas, Cassia, Gooding, Jerome, Lincoln, Minidoka, and Twin Falls Counties Acequia Albion Almo Bellevue Bliss Buhl Burley Carey Castleford Corral Declo Dietrich Eden Elba Fairfield Filer Gooding Hagerman Hailey Hansen Hazelton Heyburn Hill City Jerome Ketchum Kimberly Malta Minidoka Murtaugh Oakley Obsidian Paul Picabo Richfield Rogerson Rupert Shoshone Sun Valley Twin Falls Wendell Region 6: Bannock, Bear Lake, Bingham, Caribou, Franklin, Oneida, and Power Counties Aberdeen American Falls Arbon Arimo Atomic City Bancroft Basalt Bern Blackfoot Bloomington Chubbuck Clifton Conda Dayton Dingle Downey Firth Fish Haven Fort Hall Franklin Freedom Geneva Georgetown Grace Holbrook Inkom Lava Springs Malad City May McCammon Mink Creek Montpelier Moreland Ovid Paris Pingree Pocatello Portneuf Preston Rockland Saint Charles Shelley Region 7: Bonneville, Butte, Clark, Custer, Fremont, Jefferson, Lemhi, Madison, and Teton Counties Ammon Cobalt Hamer Lemhi Newdale Saint Anthony Arco Darlington Howe Leslie Northfork Salmon Ashton Driggs Idaho Falls Lewisville Palisades Shoup Butte City Dubois Iona Mackay Parker Stanley Carmen Ellis Irwin Macks Inn Rexburg Stone Challis Felt Island Park Menan Rigby Sugar City Chester Gibbonsville Leadore Monteview Ririe Swan Valley Clayton Grouse Ledmore Moore Roberts Tendoy December 18, 2014 Soda Springs Springfield Sterling Sublett Swan Lake Thatcher Wayan Weston Whitney Terreton Teton Tetonia Ucon Victor Page 5 of 12 Idaho MMIS Provider Handbook 6. Directory Children’s Developmental Disabilities (DD) Program The Regional Children’s DD Program is responsible for prior authorization (PA) of: • DD service coordination (case management) for children. • Intensive behavioral intervention by developmental disabilities agencies. Region 1 2195 Ironwood Court Coeur d’Alene, ID 83814 1 (208) 769-1406 Region 2 P.O. Drawer B Lewiston, ID 83501 1 (208) 799-3460 Region 3 3402 Franklin Rd. Caldwell, ID 83605 1 (208) 465-8460 Region 4 1720 Westgate, Suite B P.O. Box 83720 Boise, ID 83720-0026 1 (208) 334-0900 Region 5 803 Harrison St. Twin Falls, ID 83301 1 (208) 736-2182 Region 6 421 Memorial Dr. Pocatello, ID 83201 1 (208) 234-7900 Region 7 2475 Leslie Ave. Idaho Falls, ID 83402 1 (208) 525-7223 December 18, 2014 Page 6 of 12 Idaho MMIS Provider Handbook 7. Directory Healthy Connections (HC) The HC Program is the name of Idaho Medicaid’s Primary Care Case Management (PCCM) model of managed care. Questions regarding this program can be answered by calling one of the health resources coordinators in the regions listed below. Region 1 1120 Ironwood, Suite 102 Coeur d’Alene, ID 83814-2659 1 (208) 666-6766 1 (800) 299-6766 Region 2 1118 F St. P.O. Drawer B Lewiston, ID 83501 1 (208) 799-5088 1 (800) 799-5088 Region 3 3402 Franklin Rd. Caldwell, ID 83605-6932 1 (208) 455-7244 1 (800) 494-4133 Region 5 601 Poleline Rd., Suite 3 Twin Falls, ID 83301 1 (208) 736-4793 1 (800) 897-4929 Region 6 1090 Hiline, Suite 211 Pocatello, ID 83201-2902 1 (208) 235-2927 1 (800) 284-7857 Region 7 150 N. Shoup St., Suite 20 Idaho Falls, ID 83402 1 (208) 528-5786 1 (800) 919-9945 515 N 16th Payette, ID 83661 1 (208) 642-7006 1 (800) 494-4133 Region 4 1720 Westgate, Suite A Boise, ID 83704 or P.O. Box 83720 Boise, ID 83720-0026 1 (208) 334-4676 1 (800) 354-2574 December 18, 2014 Spanish Interpretive Service: For the HC Program statewide 1 (800) 378-3385 Page 7 of 12 Idaho MMIS Provider Handbook 8. Directory Prior Authorization (PA) Contacts Dental DentaQuest - Idaho Smiles Program 1 (800) 936-0978 http://www.dentaquest.com/ Pharmacy Pharmacy P.O. Box 83720 Boise, ID 83720-0009 www.medicaidpharmacy.idaho.gov 1 (208) 364-1829 1 (866) 827-9967 Hospital Inpatient and Select Medical Procedures Qualis Health 10700 Meridian Avenue North Suite 100 Seattle, WA 98133-0400 1 (800) 783-9207 Fax: 1 (800) 826-3836 https://www.qualishealth.org/healthcareprofessionals/idaho-medicaid DME Specialist, Medical Care P.O. Box 83720 Boise, ID 83720-0009 1 (866) 205-7403 Fax: 1 (877) 314-8782 Attn: DME Specialist Preventive Health Assistance PHA Unit P.O. Box 83720 Boise, ID 83720-0009 1 (877) 364-1843 1 (208) 364-1843 Fax: 1 (877) 845-3956 Medical and Surgical Medical Care P.O. Box 83720 Boise, ID 83720-0009 Attention: Medical Authorizations 1 (208) 287-1148 Fax: 1 (877) 314-8779 Transportation Non-Emergency Medical Transportation American Medical Response (AMR) 1 (877) 503-1261 Fax: 1 (877) 503-1262 http://www.idahonemt.net/ Medical Equipment and Supplies Ambulance Review Medical Care P.O. Box 83720 Boise, ID 83720-0009 Attention: Ambulance Review 1 (208) 287-1157 1 (800) 362-7648 Behavioral Health - Outpatient Optum Idaho 205 E. Water Tower Lane Meridian, ID 83642 1 (855) 202-0983 www.OptumIdaho.com December 18, 2014 Page 8 of 12 Idaho MMIS Provider Handbook 9. Directory Regional Medicaid Services (RMS) Region 1 1120 Ironwood Dr., Suite 102 Coeur d’Alene, ID 83814-2659 1 (208) 769-1567 Region 2 1118 F St. P.O. Drawer B Lewiston, ID 83501 1 (208) 799-4430 Region 3 3402 Franklin Rd. Caldwell, ID 83605-6932 1 (208) 455-7150 Region 4 1720 Westgate, Suite A P.O. Box 83720 Boise, ID 83720-0026 1 (208) 334-0940 Region 5 601 Poleline, Suite 3 Twin Falls, ID 83303 1 (208) 736-3024 1 (800) 826-1206 Region 6 1070 Hiline Rd, Suite 260 Pocatello, ID 83201-2955 1 (208) 239-6260 Region 7 150 Shoup Ave. Suite 20 Idaho Falls, ID 83402 1 (208) 528-5750 December 18, 2014 Page 9 of 12 Idaho MMIS Provider Handbook Directory 10. Third Party Recovery (TPR) and Crossover Claim Contacts HMS P.O. Box 2894 Boise, ID 83701 1 (208) 375-1132 1 (800) 873-5875 Monday through Friday (excluding holidays) 8 a.m. - 5:30 p.m. MT Part A Medicare (Both Regular and Railroad (RRB) Provider Noridian Administrative Services LLC Medicare P.O. Box 6726 Fargo, ND 58108-6726 1 (877) 908-8437 1 (877) 425-2371 TTY Closed each Friday from 7:30-9:30 a.m. PT Beneficiary 1 (800) 633-4227 1 (800) 633-4223 Part B Medicare Provider Noridian Administrative Services LLC Medicare P.O. Box 6726 Fargo, ND 58108-6726 1 (877) 908-8437 1 (877) 425-2371 TTY Closed each Friday from 7:30-9:30 a.m. PT Beneficiary 1 (800) 633-4227 1 (800) 633-4223 Provider 1 (877) 288-7600 Beneficiary 1 (800) 833-4455 Part B Medicare (Railroad – RRB – only) Palmetto GBA, RRB Medicare Part B P.O. Box 10066 Augusta, GA 30999-0001 Medicare Hospice, Home Health, and Rural Health Claims United Government Services, LLC CA Medicare P.O. Box 9140 Oxnard, CA 93031-9140 1 (866) 264-4990 Durable Medical Equipment Regional Carrier (DMERC) * DMERC — Region D (CIGNA Health Care) P.O. Box 690 Nashville, TN 37202 * DMERC Region D handles all durable medical equipment (DME), immunosuppressive drugs, enteral/parenteral nutrients (PEN), prosthetics, orthotics, and supplies December 18, 2014 Provider 1 (866) 243-7272 Public Relations 1 (866) 224-3094 Beneficiary 1 (800) 899-7095 Beneficiary Claim Services (automated)1 (877) 320-0390 Page 10 of 12 Idaho MMIS Provider Handbook Directory 11. Molina Medicaid Solutions Health PAS-OnLine – www.idmedicaid.com 11.1. MACS Medicaid Automated Call Service (MACS) 1 (888) 686-4272 1 (208) 373-1424 MACS is available 24 hours a day, seven days a week. Provider service representatives are available Monday through Friday, 7:00 A.M.-7:00 P.M. MT. 11.2. Addresses and Phone Numbers Service Area Address Phone Fax Member Services P.O. Box 70081 Boise, ID 83707 1 (866) 686-4752 1 (208) 373-1432 1 (877) 517-2039 Provider Enrollment P.O. Box 70082 Boise, ID 83707 1 (866) 686-4272 1 (208) 373-1424 1 (877) 517-2041 Provider Services P.O. Box 70082 Boise, ID 83707 1 (866) 686-4272 1 (208) 373-1424 1 (877) 661-0974 1 (866) 686-4272 1 (208) 373-1424 1 (877) 517-2040 IDMemberServices@MolinaHealthcare.com IDProviderEnrollment@MolinaHealthcare.com IDProviderServices@MolinaHealthcare.com Technical Services IDEDISupport@Molinahealthcare.com Claims Review Request Form P.O. Box 70082 Boise, ID 83707 Utilization Management Case Management Healthy Connections P.O. Box 70081 Boise, ID 83707 CMS-1500 Claims UB-04 Crossover CMS1500 Crossover Third Party Recovery (TPR) P.O. Box 70084 Boise, ID 83707 UB04-Institutional Claims Financial/ADA 2006 Claims P.O. Box 70087 Boise, ID 83707 December 18, 2014 Page 11 of 12 Idaho MMIS Provider Handbook Directory 11.3. Molina Regional Provider Relations Consultants (PRCs) Region 1 and the state of Washington Region.1@MolinaHealthCare.Com 1 (208) 559-4793 Region 2 and the state of Montana Region.2@MolinaHealthCare.Com 1 (208) 991-7138 1120 Ironwood Dr., Suite 102 Coeur d’Alene, ID 83814-2659 1118 F Street P.O. Drawer B Lewiston, ID 83501 Region 3 and the state of Oregon Region.3@MolinaHealthCare.Com 1 (208) 860-4682 3402 Franklin Rd. Caldwell, ID 83605 Region 4 and all other states Region.4@MolinaHealthCare.Com 1 (208) 373-1343 9415 W. Golden Trout Way Boise, ID 83704 Region 5 and the state of Nevada Region.5@MolinaHealthCare.Com 1 (208) 484-6323 601 Poleline Road, Suite 7 Twin Falls, ID 83301 Region 6 and the state of Utah Region.6@MolinaHealthCare.Com 1 (208) 870-3997 1070 Hiline Rd. Pocatello, ID 83201 Region 7 and the state of Wyoming Region.7@MolinaHealthCare.Com 1 (208) 528-5728 December 18, 2014 150 Shoup Ave. Idaho Falls, ID 83402 Page 12 of 12
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