All providers wishing to participate in the Idaho Medicaid Program must first register for a Trading Partner Account (TPA) at www.idmedicaid.com.
- Select “Register” in the upper right hand corner to complete the TPA registration. Once complete, follow the link for the Provider Enrollment Application after logging in.
- Complete the Provider Enrollment Application. A complete application includes a Medicaid Provider Enrollment Agreement and a W9, which must be signed by the provider and submitted with the enrollment application along with other attachments through the website to Gainwell.
If you need additional assistance in completing the application, call 1-866-686-4272.
Provider application questions
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 Gainwell.
Any exceptions to this policy must be requested in writing, providing justification as to why the applicant's effective date should be different. Typically approved exceptions include emergency services or 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.
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.