Idaho Association of Community Providers - IACP

09/05/2025

ATTN: Behavioral Health Providers!!!!

🚨 Important Update for Idaho Behavioral Health Providers from MAGELLAN 🚨

New Medicaid Enrollment Requirements Started May 5, 2025

In compliance with federal rules and the Social Security Act, Idaho Medicaid is requiring all behavioral health providers to enroll through the Medicaid Enterprise System (MES). This is essential for remaining eligible to provide services and receive reimbursement under the Idaho Behavioral Health Plan, managed by Magellan.

🗓 Key Dates:

Enrollment Opens: May 5, 2025

Deadline to Enroll: July 31, 2025

📌 What This Means for You:

All providers must enroll with Gainwell Technologies (GWT), the MES vendor.

You must be enrolled to continue contracting, participating in the network, and receiving reimbursement from Magellan.

This applies to new enrollments and Ordering, Referring, Prescribing (ORP) providers.

💡 Resources & Support:

Visit 👉 www.idmedicaid.com and navigate to the Prospective Providers and Enrollment resources page.

Review the Feb. 11, 2025 Medicaid Provider Information Release from IDHW for full details and step-by-step guidance.

📩 Questions?
Email Magellan at IdahoProvider@MagellanHealth.com.

Let’s work together to stay compliant and continue serving our Idaho Medicaid members! 💙

Gainwell Technologies was able to implement a change to the upgraded Provider Enrollment Application system to modify how DEA information is validated. Users who were entering a DEA number for a provider and receiving the error "Required valid DEA #" are now able to enter the DEA # and successfully....

23/04/2025

📣 Magellan System Maintenance Alert
Heads up, providers! ⏰

Magellan’s authorization system (accessed via Availity Essentials) will be unavailable starting at 10 p.m. MDT on Saturday, April 26, due to scheduled updates. The system is expected to be back up by 6 a.m. MDT on Sunday, April 27.

Should any issues arise during this window, Magellan will notify providers of additional downtime. Otherwise, systems will be fully operational after the update.

❓Questions?

Reach out to: IdahoProvider@MagellanHealth.com

21/04/2025

16/04/2025

📣 Provider Update from Magellan

What is a Retrospective Review?

A retrospective review is an evaluation of the medical necessity of services after they’ve already been provided—without preauthorization.

Providers can request a retrospective review when clinical circumstances prevented them from obtaining the required preservice review and no claim has been filed yet.

👉 Situations that may qualify include:

Emergency services

Member’s condition made it impossible to confirm eligibility

Retroactive initiation of Idaho Behavioral Health Plan or Medicaid

Service wasn’t covered by the member’s primary insurance

📋 To request a review, submit:

Magellan Retrospective Review Request Form

Member info (name, ID, DOB, address)

Type of service + dates + number of units

Clinical documentation supporting medical necessity

Proof of retroactive eligibility

EOB or denial letter from primary insurance

📠 Fax to: 1-888-656-2586 (Attn: Retrospective Review)
📧 Questions? Email: IdahoProvider@MagellanHealth.com

Stay informed and ensure timely submissions—thank you for the care you provide!

03/04/2025

Magellan update:

Overview
An operational update made in the Magellan Authorization System on March 19 to the Place of Service field has generated an unanticipated reaction, exclusively affecting Inpatient (IP) authorizations being extended.

The Magellan Authorization System IP line-item Place of Service field will display both the disabled option and the new option to be selected.
The system will display an error message if the existing authorization includes the disabled option.
Providers may encounter errors specifically when entering an extension request for authorizations that were originally submitted prior to March 19 due to the system’s inability to process extensions with the now-disabled Place of Service values.
Provider Action Required:

Providers will be unable to submit an extension request for any existing, open authorizations that use the disabled Place of Service values for Inpatient authorizations.
If an error occurs, providers must submit extension requests via:
Fax: 1-888-656-2586
Phone: 1-855-202-0983

The authorization system internal team is proactively reviewing open IP authorizations and editing Place of Service values for line items with upcoming end dates. This process will continue sequentially.
Disabled Place of Service values
IBHP Services:

ASAM 3.1 Sub Related Disorder
ASAM 3.2 Detox
ASAM 3.3 Sub Related Disorder
ASAM 3.5 Sub Related Disorder
ASAM 3.7 Detox
ASAM 3.7 Sub Related Disorder
ASAM 4 Detox
ASAM 4 Sub Related Disorder

Homes with Adult Residential Treatment (HART)
Inpatient Psychiatric
Psychiatric Residential Treatment Facility (PRTF)
Residential Treatment - Substance Use
We appreciate your cooperation as we work through this issue. If you have any questions, please contact us for further assistance.

Questions?
Please contact Magellan at IdahoProvider@MagellanHealth.com.

31/03/2025

Magellan Update - Treatment Plans

The updated Idaho Behavioral Health Plan (IBHP) Provider Handbook Supplement – Appendix C initially included a requirement for treatment plans to have a signature. However, based on feedback received, we have removed this requirement for most treatment plans. Signatures will still be required for the following:

Person-Centered Service Plans
Child and Family Teams (CFTs)
Skills Training CBRS Treatment Plans
While signatures are no longer mandatory for other treatment plans, obtaining them remains a best practice. We will include the verbiage above in the next set of updates to Appendix C.

Questions?
If you have any questions, please contact Magellan at IdahoProvider@MagellanHealth.com.

26/03/2025

Attn: Behavioral Health Medicaid Providers:

MEDICAID INFORMATION RELEASE MA25-01

Providers MUST enroll with Idaho Medicaid MES vendor Gainwell Technologies (GWT) in order to continue to provide services to Medicaid participants served through an MCO.

Providers should begin their enrollment process during their identified enrollment phase listed below.

All provider types that bill Medicaid must be enrolled, even in instances where a provider
may bill Medicare as the primary payer, or when there is any Medicaid cost sharing.

For resources to support you in either a New Enrollment or ORP Enrollment, please visit the
Prospective Providers and Enrollment resources page on www.idmedicaid.com.

Behavioral Health Providers
Enrollment Start Date: May 5, 2025
Enrollment End Date: July 31, 2025

26/03/2025

🚨 Important Update for Idaho Behavioral Health Providers! 🚨

Idaho Medicaid is implementing new provider enrollment requirements in compliance with federal regulations. If you provide behavioral health services to Medicaid members through Magellan (the Managed Care Organization for the Idaho Behavioral Health Plan), you must enroll to remain eligible for reimbursement and network participation.

🗓 Key Dates:
✔️ Enrollment Opens: May 5, 2025
✔️ Deadline to Enroll: July 31, 2025

🔹 What This Means for You:
✅ All behavioral health providers must enroll through Idaho Medicaid’s MES vendor, Gainwell Technologies (GWT) to continue providing services.
✅ Enrollment is required to maintain eligibility for contracting, network participation, and reimbursement.

📌 How to Enroll:
💻 Visit the Prospective Providers and Enrollment Resources page at www.idmedicaid.com for guidance on New Enrollment or Ordering, Referring, Prescribing (ORP) Enrollment.
📄 Review the Feb. 11, 2025 Medicaid Provider Information Release for detailed instructions and FAQs.

⚠️ Failure to enroll by July 31, 2025, may result in the inability to provide services to Medicaid members.

For questions or assistance, contact Magellan at IdahoProvider@MagellanHealth.com.

Gainwell Technologies was able to implement a change to the upgraded Provider Enrollment Application system to modify how DEA information is validated. Users who were entering a DEA number for a provider and receiving the error "Required valid DEA #" are now able to enter the DEA # and successfully....

26/03/2025

🌟 Youth Peer Support Training – Apply Now! 🌟

Are you a Certified Peer Support Specialist (CPSS) with lived experience navigating mental health or co-occurring conditions in your youth? Do you want to support and empower youth (ages 12-17) on their journey?

The next Youth Peer Support training will be held live on Zoom:
📅 April 22-25, 2025 (Tuesday–Friday)
🕘 9 AM–2:30 PM MT / 8 AM–1:30 PM PT (includes a 30-min lunch break)
📌 Final exam on April 25 (not timed, taken live on Zoom)

🔹 Application deadline: March 31, 2025
🔹 Certificate of completion issued by Magellan Healthcare of Idaho (valid within Idaho Medicaid)

Trainee qualifications:
✅ CPSS certification required
✅ Personal lived experience with mental health in youth
✅ In recovery for at least one year
✅ Pass phone screening & background check

🎯 Why become a Youth Peer Support Specialist?
✔️ Make a real impact by supporting youth on a peer-to-peer level
✔️ Strengthen connections with youth culture
✔️ Gain specialized training to enhance your skills

Limited seats available! Apply today! 📩

For more details & to apply ➡️ [Insert Application Link]

Questions? Email Amber Leyba-Castle at degiulioa@magellanhealth.com

Magellan Healthcare is pleased to work with the Idaho Department of Health and Welfare (IDHW) to advance mental health, substance use disorder and youth services. The Idaho Behavioral Health Plan (IBHP) coordinates behavioral health benefits for Medicaid members and other Idaho residents. Magellan i...

18/03/2025

Attention:

Magellan IBHP handbook supplement - Appendix C updated effective April 7.

Overview
The program services appendix in the IBHP Provider Handbook Supplement (Appendix C) has been updated, effective April 7, 2025. You can now review the updated version, and the revision log, on the MagellanofIdaho.com website under For Providers / Provider Handbooks.

Questions?
For questions, please contact IdahoProvider@MagellanHealth.com.
www.MagellanofIdaho.com

Magellan Healthcare is pleased to work with the Idaho Department of Health and Welfare (IDHW) to advance mental health, substance use disorder and youth services. The Idaho Behavioral Health Plan (IBHP) coordinates behavioral health benefits for Medicaid members and other Idaho residents. Magellan i...