What's New?
ICD-10 Diagnosis code changes Effective 10/01/2015

Dear Providers,
Idaho Medicaid is in compliance with requirements to update from ICD-9 to ICD-10 diagnosis codes. This means the diagnosis code that you currently submit on your claim will change October 1, 2015.
What you need to do as of 10/1/2015:

  1. Ensure the method you use to submit claims will allow for the new ICD-10 code and format.
    1. If you are submitting claims electronically (EDI) through your Trading Partner Account with Molina Medicaid Solutions, the system has been updated to allow the new code set to be received. 
    2. If you are submitting claims one at a time using the provider portal, you will be required to indicate whether you are submitting an ICD-9 or an ICD-10 coded claim for the date of service.  A radio button will be available for selecting this indicator.  The diagnosis code version to be used on the claim is based on the date of service.
      1. For claims with a date of service of 9/30/2015 or earlier, an ICD-9 code is required
      2. For claims with a date of service of 10/1/2015 or later, an ICD-10 code will be required.
    3. If you submit paper claims, verify you are using the updated (2/2012) CMS 1500 form.
  2. If you submit claims electronically through a different software or tool, you will need to ensure with your vendor that these have been updated to allow for the ICD-10 code and format.
  3. Know and submit the correct diagnosis code on your claims based on the dates of service.  The diagnosis code that you bill with depends on individual participant’s services and health conditions. 
    1. For example:  If you currently bill with the ICD- 9 diagnosis code V60.4 “No other household member able to render care,” effective 10/1/2015 you will need to start using the ICD-10 compliant diagnosis code of Z74.2 “Need assistance at home and no other household member able to render care.”
      1. For dates of service of 9/30/2015 or earlier, continue to use the ICD-9 code on claims
      2. For dates of service of 10/1/2015 or later, use the new ICD-10 code on claims
    2. If you use an ICD-9 diagnosis code other than V60.4, you will need to identify the correct ICD-10 to use. You can find diagnosis code information in the Provider Handbook at www.idmedicaid.com > Provider Handbook > Claim Form Instructions > CMS 1500 Instructions. You may also find additional diagnosis code information in the ICD-10 Coding book or online at www.icd10data.com.    
    3. If you use a billing agency to submit claims on your behalf, please communicate these changes to them.

Idaho Medicaid has also provided several online resources to help you in this transition. Additional information can be found on the Molina Medicaid website at www.idmedicaid.com under the following links:

  1. Idaho Medicaid ICD-10
  2. Provider Handbook > Claim Form Instructions > CMS 1500 Instructions
  3. Training > Training Documents > Claims and Billing

Idaho Department of Health and Welfare


School-Based Medicaid

The State Department of Education and the Department of Health and Welfare, Division of Medicaid, come together quarterly as a School-Based Medicaid Advisory Committee. These meetings are necessary to help facilitate better communication between school districts (School- Based Medicaid providers), Medicaid policy, and Medicaid Integrity.  This committee meets to address changes in School-Based Medicaid IDAPA rules, discuss audit findings and ways to make practice corrections, as well as providing clarification to districts on School-Based Medicaid policies and procedures.  This site provides the minutes to Advisory meetings, documentation that is relevant to the implementation of School-Based Medicaid rules, training material, and other related materials. 

NEGOTIATED RULEMAKING 2015  Comments from Statewide meetings.

06-19-15 CDA Comments

06-17-15 Boise Comments

06-17-15_Pocatello Comments


Title:  Districts Using Contracted Behavioral Supports (Habilitative Intervention (HI) Providers)

The Division of Family and Community Services (FACS) is responsible for processing the renewal applications for individuals who hold a Habilitative Intervention (HI) Certificate of Completion as outlined in IDAPA

FACS has identified renewal applications that are not consistently meeting the required number of continuing training hours.  FACS will incorporate the following steps to address these renewals that are out of compliance with IDAPA.

When an individual submits the renewal application for their Certificate of Completion, if it is determined that the individual did not meet the HI continuing training requirement during year one (1), and a gap in training hours occurred, a letter will be sent to the HI Certificate of Completion holder and a letter will be sent to the Medicaid provider identifying that the staff’s qualifications are out of compliance with IDAPA. 

It is the responsibility of Medicaid providers (Developmental Disability Agencies, School Districts, and Charter Schools) to ensure that HI providers are qualified to provide services.  The Medicaid provider is responsible for ensuring the accuracy of claims submitted and shall immediately repay the Department for any services the Department or provider determines were not properly provided or documented.

If you have questions with regards to the Habilitative Intervention Certificate of Completion continuing training requirements, please contact Bobbi Hamilton, BCaBA at hamiltob@dhw.idaho.gov or 1 (208) 334-5777.

For additional resources including IDAPA rule and current forms please visit: www.sbs.dhw.idaho.gov

For School-Based Medicaid questions please contact either:

Frede' Trenkle-MacAllister
Alternative Care Coordinator
Idaho Department of Health and Welfare Medicaid
Phone:   (208) 287-1169
Fax:   (208) 332-7286


Shannon Dunstan
Early Childhood and Interagency Coordinator Idaho State Department of Education P.O. Box 83720 Boise, Idaho   83720
208-332-6908 (Office)
208-703-1660 (Cell)