Provider Resources

Provider Bulletins

• Provider Bulletin: Surgical Reviews (June 21, 2011)
   

Provider Manual

• Idaho Medicaid Provider Manual (January 2012)
   

Forms

• Pre-authorization List
  Also known as Appendix A in the Idaho Medicaid Provider Manual
• Checklist for Procedure Authorization Reviews
 

Idaho Administrative Code

• Medicaid Basic Plan Benefits
• Medicaid Enhanced Plan Benefits
   

Provider Manual Exhibits

• Exhibit 2: Pre-service Review Request Fax Form
• Exhibit 5: Concurrent Review Request Fax Form
• Exhibit 7: Psychiatric Admit Notification Information(for individuals under the age of 21)
• Exhibit 8: Psychiatric Worksheet for Pre-service Review (for clients 21 years or older)
• Exhibit 9: Psychiatric Review Worksheet for Concurrent Review (for clients of all ages)
• Exhibit 10: Physical Rehabilitation Review Worksheet for Pre-service Review
• Exhibit 12: Retrospective Review Request Form
• Exhibit 13: Administratively Necessary Days (ANDs) Intake Form
• Exhibit 19: Notification of Birth: Anticipated Stays Greater than 72 Hours
• Exhibit 20: iEXCHANGE® Sample of IMD Questionnaire

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