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Medicaid Providers

Idaho Medicaid is a medical insurance program that serves as a safety net for people who have low incomes, have a disability, or are elderly.
Idaho offers four different plans to meet the individual needs of participants. 
  • Standard – Provides only federally mandated benefits. All participants have the option to select this Standard Plan.
  • Basic – Benefits include preventive as well as medical, dental, and vision services for participants who meet income standards.
  • Enhanced – Benefits include Basic Plan benefits plus long-term, developmental disability, and mental health services and supports for participants who are eligible due to disabilities or have special health needs.
  • Medicare-Medicaid Coordinated – For participants who are eligible and enrolled in both Medicare and Medicaid. This plan includes the same benefits identified in the Enhanced Plan but include an option to receive services through a Medicare Advantage Plan of their choice. 
Effective June 7, 2010, Idaho Medicaid contracted with Molina Medicaid Solutions to be the MMIS claims processing center as well as provide provider training, billing, and operational support for all Medicaid providers.  
 
Magellan Medicaid Administration is providing these services for the pharmacy program.
 
For more information on the Idaho Medicaid Program visit the Medicaid home page.

Provider Exclusion List

Provider Applications

Additional Guidelines & Frequently Asked Questions  for Provider Applications
 
The effective date of an applicant's enrollment as an Idaho Medicaid provider is deemed to be the date the completed and acceptable application is received by the Department of Health and Welfare or Molina Medicaid Solutions.
 
Any exceptions to this policy must be requested in writing by providing justification as to why the applicant's effective date should be a different date. Exceptions that are typically approved are if emergency services were provided or for covered specialist services that otherwise would be available to a Medicaid Participant. 
The requested effective date must be noted and must be covered by any applicable license or certification submitted with the application.  All claims must be submitted to Idaho Medicaid within twelve months (365 days) from the date of service. The only exception to this requirement is for Medicare crossover claims.  If a claim for payment under Medicare has been filed in a timely manner, Medicaid will consider claims for payment within six months of the date of payment or date of the EOB of the Medicare claim.
 
Who do I contact with questions regarding the Medicaid Provider Enrollment/Applications? 
Molina Provider Enrollment at 1-866-686-4272.
 
When I become a Medicaid provider, do I get reimbursed for what I bill?
For most services, Idaho Medicaid reimburses providers the maximum allowable fee established by the Idaho Department of Health and Welfare, Division of Medicaid, OR the billed amount, whichever is lower.

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