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HomeMy WebLinkAboutEnrollment Instructions for Independent Intervention Specialist and Professional ProvidersRevised July 1, 2025 Page 1 of 5 CHIS INDEPENDENT PROVIDER ENROLLMENT INSTRUCTIONS | Effective July 1st, 2025 Children’s Habilitation Intervention Services (CHIS) Independent Intervention Specialist and Intervention Professional PROVIDER ENROLLMENT INSTRUCTIONS For Visual Page by Page Gainwell/Medicaid Enrollment Instructions go to Step 5! CHIS provider enrollment is completed and monitored by the Children’s Developmental Disabilities Program under Medicaid. To process your application, you must follow the steps below. Enrollment to become an Independent CHIS provider is a multi-step process: 1. Complete an Idaho Background Check. This must be completed before you complete your New Medicaid Provider Enrollment Application. 2. Complete/have current CPR and First-Aid Certifications. 3. Obtain General Liability Insurance. 4. Obtain a National Provider Identifier (NPI). 5. Submit the Medicaid Provider Enrollment Application online. 6. Submit Education/Experience/Competency Documentation and CPR-First Aid Certifications to Children’s DD. 7. Register as a provider with Telligen. Carefully follow all steps of the process to assure your enrollment is expedited. Step 1 – Have Completed an Idaho Background Check ➢ If you have never had an Idaho Background Check or you have completed an Idaho Background Check, but it is over 3 years old, go to https://bcu.dhw.idaho.gov/applicant to register and then you can submit an application. You will be asked for a Pay Code which is QTKBYM and the type of service is Home and Community Based Services (HCBS) – Children. ➢ If you have completed an Idaho Background Check and it is less than 3 years old, go to https://bcu.dhw.idaho.gov/applicant to register. You will be asked for a Pay Code which is QTKBYM and the type of service is Home and Community Based Services (HCBS) – Children and then you can submit an application. If your previous clearance can be used, then you will have connection features that will display in the application. You will need to email medicaidchildrensdd@dhw.idaho.gov and request the ISP Name Based Criminal Background Check form. Step 2 – Current CPR and First-Aid Certifications You must have current CPR-First Aid certifications at the time of enrollment and maintain these certifications. Documentation must be submitted to the Children’s DD as outlined in Step 6. Step 3 – General Liability Insurance You must obtain and maintain general liability insurance. Documentation must be submitted to Gainwell Technologies (GWT) with the New Medicaid Provider Enrollment Application as outlined in Step 5. Professional liability does not meet the general liability requirement. ➢ What is the difference between general and professional liability insurance? Revised July 1, 2025 Page 2 of 5 CHIS INDEPENDENT PROVIDER ENROLLMENT INSTRUCTIONS | Effective July 1st, 2025 ❖ General liability protects against physical injury to people or damage to property arising from daily operations. For example, a customer who falls through a board on their newly built deck could sue the hired contractor for faulty workmanship and bodily injury. ❖ Professional liability covers negligence related to professional services or advice. It’s generally related to financial loss vs physical injury or damages. For example, a consultant could face a lawsuit for providing bad advice that resulted in financial loss to their client. No one was injured, and no property was damaged, like in a general liability claim. Step 4 – National Provider Identifier (NPI) A National Provider Identifier (NPI) is required for providers to enroll. If you do not have an NPI, you will complete the application at https://nppes.cms.hhs.gov/#/ ➢ If you are an Evidence Informed Model (EI) Intervention Specialist/Professional and unsure of the taxonomy code to use, you may use 222Q00000X. ➢ If you are an Evidence Based Model (EBM) Intervention Specialist and unsure of the taxonomy code to use, you may use 106S00000X. ➢ f you are an Evidence Based Model (EBM) Intervention Professional and unsure of the taxonomy code to use, you may use 103K00000X. Step 5 – New Medicaid Provider Enrollment Application ➢ Visual Page by Page Enrollment Instructions-Click Here! ➢ Complete Trading Partner Account (TPA) registration. See the TPA Provider Not Yet Enrolled Registration Guide for State of Idaho MMIS for detailed TPA registration instructions. ➢ Register and sign into the GWT Medicaid website at www.idmedicaid.com. Once you are signed in, hover over the Account Maintenance tab and select Provider Enrollment. ❖ Refer to the User Guide at https://www.idmedicaid.com/User%20Guides/Forms/AllItems.aspx for step-by-step instructions. For instructions click “New Provider Enrollment Guide – Individual.” ➢ Click New Medicaid Provider Enrollment Application. ➢ Fill in all required fields. When the application asks for information regarding a business, this information is your personal information such as address and phone, etc. Independent providers may not enroll as an agency business. HERE ARE SOME TIPS: Application Questions: Select in Drop Down Menu: Business Enumeration Type Type 1 - Individual Business Enrollment Type Individual Tax ID Type SSN/FEIN Provider Type Behavioral Health & Social Services Provider Specialty DD Child Independent Therapeutic Consultation Population Served Children 0 to 21 years old **By enrolling as an independent provider, you understand and agree that by direct receipt of the funds, you are assuming potential tax and employer responsibilities that may include, but are not limited to, worker’s compensation, employee withholding, unemployment insurance, and liability insurance. Revised July 1, 2025 Page 3 of 5 CHIS INDEPENDENT PROVIDER ENROLLMENT INSTRUCTIONS | Effective July 1st, 2025 ➢ Complete all required documentation displayed at the end of the New Medicaid Provider Enrollment Application. Some of the required documents may be signed electronically, and others require downloading, signing and uploading the signed copy to the section at the end of the New Medicaid Provider Enrollment Application. The required documentation includes the following: ❖ Medicaid Provider Agreement ❖ W9 ❖ EFT Agreement ❖ Idaho Background Check Notice of Clearance, and ❖ General Liability Insurance. ➢ Click Submit. The system will respond with a case number. Use this case number whenever you contact GWT or the Children’s DD about your application. If the New Medicaid Provider Enrollment Application is incomplete or updates are necessary, you will receive an email indicating the items that are incomplete within 3-5 business days from the submission. You will then submit missing information or updates through the Provider Enrollment Application. ❖ Note – If a New Medicaid Provider Enrollment Application is started, but not submitted, the online Application will expire in 14 calendar days and you will have to redo the entire application again. Step 6 – Submit Education/Experience/Competency Documentation/CPR & First Aid Certifications to the Children’s DD for Review You will use the provider document portal posted on the external website https://healthandwelfare.idaho.gov/childrens-developmental-disability-forms Instructions on how to use the portal are posted on the external website https://publicdocuments.dhw.idaho.gov/WebLink/DocView.aspx?id=19057&dbid=0&repo=PUBLIC- DOCUMENTS&cr=1 ➢ CPR/First Aid Certifications ➢ Degree and experience: ❖ Intervention Specialist o Diploma/Transcript showing bachelor’s degree in a human services field or bachelor’s degree in any field with 24 semester credits in a human services field, and o Documentation outlining 1,040 hours of supervised experience with individuals’ birth (0) to twenty-one (21) who demonstrate functional or behavioral needs, and o For intervention specialists who complete assessment and clinical treatment plans, you must have a minimum of ten (10) hours of documented training and five (5) hours of supervised experience in designing comprehensive assessments and implementation plans for individuals with functional or behavioral needs. ❖ Intervention Professional o Diploma/Transcript showing master’s degree or higher in psychology, education, or applied behavior analysis or related discipline with twenty-four (24) upper division semester credits of relevant coursework in specific content areas, and o Documentation outlining one thousand, twelve hundred (1,200) hours of relevant experience in designing and implementing comprehensive behavioral therapies for children with functional or behavioral needs. ❖ EBM Intervention Specialist Revised July 1, 2025 Page 4 of 5 CHIS INDEPENDENT PROVIDER ENROLLMENT INSTRUCTIONS | Effective July 1st, 2025 o Bachelor-level EBM certification or credential. ❖ EBM Intervention Professional o Master-level EBM certification or credential. ➢ Competency ❖ Intervention Specialist Only o Habilitative Intervention Certificate of Completion issued by DHW with an expiration date of July 1, 2019 or later and there is not a gap of more than three (3) consecutive years as an Intervention Specialist, or o Department approved Competency Checklist, or o Documentation of 40-hour applied behavior analysis training completed by an individual who is certified or credentialed to deliver the training. Note: If ISP name-based check is required, enrollment will be held until the ISP name check is received by the Children’s DD. If the application is incomplete, you will receive an email indicating the items that are incomplete within 3 - 5 business days from the date of submission. The application will not be processed if all the required documentation is not included. When review is completed and approved, an approval email will be sent outlining things you should know. Prior to rendering services, ensure you review the following Medicaid Guidelines. Medicaid Guidelines Guidelines Description Provider Handbook Information on CHIS is available in the Idaho Medicaid Provider Handbook under Provider Guidelines in Agency Professional. Fee Schedules Reimbursement Rates Procedure codes and rates for Children’s Independent Providers are located in the Provider Reimbursement Rates folder which can be found under Fee Schedules. Rules Rule requirements for CHIS are located in IDAPA 16.03.26. Independent providers must: ➢ Follow all requirements as defined in IDAPA 16.03.26. sections 180-189 “SUB AREA: CHIS” as applicable. ➢ Be supervised as outlined in IDAPA 16.03.26.183.04 if they hold a bachelor’s degree. ➢ Have program documentation for each visit made or for each service provided to the individual. This documentation must also be maintained by the provider in accordance with IDAPA 16.05.07.101.01. Website Provider service information is located on the Children's DD Provider Website for Independent Providers. Step 7 – Register as a Provider with Telligen Revised July 1, 2025 Page 5 of 5 CHIS INDEPENDENT PROVIDER ENROLLMENT INSTRUCTIONS | Effective July 1st, 2025 All CHIS require prior authorization through the Telligen Provider Portal. ➢ Provider Portal Training and registration packet can be downloaded from their website at http://idmedicaid.telligen.com/education-training. STOP: You cannot deliver services until ALL the following are completed: ➢ Receive the Children’s DD approval email, ➢ Receive GWT approval letter via email, and ➢ Receive prior authorization for services from Telligen. If you have any questions regarding this application process, please contact the Children’s DD Program at 208-334-0678 or medicaidchildrensdd@dhw.idaho.gov.