Residential Assisted Living Facility Training (RALF)
Overview At www.idmedicaid.com, you will find: Trading Partner Account (TPA) registration and sign-in Prior Authorization Patient Roster o Eligibility o Claim Submission Copy Last Claim Claim Status Remittance Advice 2
Navigating the Secure Portal 3
TPA Registration 4
Navigating the Secure Portal 5
Prior Authorization 6
Authorization Status 7
Authorization Status Search 8
Authorization Status Detail 9
Patient Roster 10
Patient Roster Add New Member 11
Patient Roster Add New Member 12
Patient Roster Verify Eligibility 13
Patient Roster Verify Eligibility 14
Eligibility 15
Eligibility A&D Waiver Coverage 16
Eligibility DD Waiver Coverage 17
Eligibility Enhanced Coverage 18
Eligibility MMCP with A&D Waiver Coverage 19
Claim Submission 20
Patient Roster Submit Claim 21
Claim Submission Professional Claim (1500) 22
Claim Submission Confirmation The claim ID displays in the upper left corner of the confirmation page. Select the Claim View link to see the detail of claim. 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.) Select the New Claim option to enter a new claim. Select Adjudicate Claim to process the claim for payment or identify any outstanding edits. 23
Claim Submission Copy Last Claim Copy Last Claim will copy over some information from the last claim submitted for this member. However, it is important to review all fields to either add additional or correct pre-populated information. 24
Claim Status 25
Claim Status Overview 26
Claim Status Search 27
Remittance Advice 28
Remittance Advice 29
Remittance Advice Banner Page 30
Remittance Advice Claim Detail 31
Remittance Advice Claim Detail 32
Remittance Advice Summary 33
Important Information As a reminder, please keep your contact information (including your mailing address) up to date at all times. This will ensure you receive important information Molina may need to communicate. 34
Did You Know?
Announcements 36
Information Releases 37
Provider Handbook 38
Provider Handbook 39
Fee Schedules 40
Fee Schedules 41
MedicAide Newsletters 42
MedicAide Newsletters 43
User Guides 44
Training 45
Idaho Medicaid Training Center 46
Training Opportunities Monthly WebEx Trainings o o Available to all providers Calendar is located at www.idmedicaid.com Regional Workshops o o Yearly Information will be posted to www.idmedicaid.com Individual Training or Questions o Contact your local Provider Relations Consultant 47
Enrollment and Maintenance
Enrollment/Maintenance Be sure to keep your information up to date. o o o o o Current contact Mailing/W9/physical/e-mail addresses Adding and terming rendering providers Adding and terming service locations Change of ownership 49
Enrollment and Maintenance 50
Enrollment and Maintenance Forms 51
Provider Maintenance 52
Provider Maintenance Maintenance is required when any information changes: Mailing/W9/physical/e-mail addresses Add, term, update service locations Rendering or service provider changes Name changes Change in ownership Note: Contact updates are made through Maintenance Demographic. 53
Tips Use current forms Complete all sections of the form use N/A when appropriate Utilize the Provider Enrollment Requirements document in the Provider Handbook for type and specialty information, as well as additional requirements New W9 for 1099 changes W9 name and tax ID must match IRS records Update provider credentials (licenses, certifications, insurance, etc.) 54
Tips Provider Maintenance The Idaho Molina Medicaid website (www.idmedicaid.com) has the following resources: Provider Enrollment - Verifying Enrollment Application Status Provider Handbook User Guides Contact Molina at 1 (866) 686-4272 or e-mail idproviderenrollment@molinahealthcare.com for assistance with enrollment or maintenance 55
Provider Relations Consultants Region 1 and the state of Washington 1 (208) 559-4793 Region.1@MolinaHealthCare.com Region 2 and the state of Montana 1 (208) 991-7138 Region.2@MolinaHealthCare.com Region 3 and the state of Oregon 1 (208) 860-4682 Region.3@MolinaHealthCare.com Region 4 and all other states 1 (208) 912-3790 Region.4@MolinaHealthCare.com Region 5 and the state of Nevada 1 (208) 484-6323 Region.5@MolinaHealthCare.com Region 6 and the state of Utah 1 (208) 870-3997 Region.6@MolinaHealthCare.com Region 7 and the state of Wyoming 1 (208) 991-7149 Region.7@MolinaHealthCare.com 56
Thank you for attending our Residential Assisted Living Facility Training. Please take a few minutes to complete the evaluation. This provides us with valuable information for future trainings.