Applications will not be backdated without approval by the Department of Health and Welfare. IDAPA 16.03.09 in Idaho Code defines a provider as “Any individual, organization, or business entity furnishing medical goods or services in compliance with this chapter and who has applied for and received a provider number, pursuant to section 020, and who has entered into a written provider agreement, pursuant to section 040.”

Based on this definition, the Division of Medicaid has made a decision as to when a provider agreement/application can be made effective and the provider will be reimbursed for services provided to a Medicaid client. 

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 EDS Provider Enrollment.

Any exceptions to this policy must be requested in writing by providing justification as to why the applicant's effective date should be backdated. Exceptions that are typically approved are if emergency services were provided or if the client was given retroactive Medicaid eligibility. 

The requested effective date must be noted and must be covered by any applicable license or certification submitted with the application.  Although backdated applications may be approved, the claim may still be denied for timely filing if a claim was not submitted within one year of the date of service, 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.

 

EDS Provider Enrollment at 1-800-685-3757.

 

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.