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Montana Medicaid
Provider Information

What's New on the Website This Week

A list of the documents posted to the website for the current week.

Current Resource-Based Relative Value Scale (RBRVS)


Final Update

Electronic Funds Transfer (EFT) and Electronic Remittance Advice (ERA) Changes

This notice supersedes all written documentation regarding EFT and ERAs, including Claim Jumper articles, provider notices, and announcements posted on the Provider Information website.

All Montana Healthcare Programs providers (Medicaid/HMK Plus, CHIP/HMK, and Mental Health Services Plan) will be moved to EFT (direct deposit) and ERA over the next two months.

In order to accomplish this transition, Xerox will eliminate both the paper remittance advice option and paper warrants/checks. Providers may be affected as early as December 1, 2014.

To avoid disruption in receiving remittance advices and payments, providers should initiate the change to EFT/ERA as soon as possible. All providers must be registered for the web portal and submit their paperwork to Provider Relations to be eligible for payment and receive applicable ERAs in 2015.

If you are enrolled in EFT, receive ERAs, completed a Trading Partner Agreement (TPA) and have already registered for the Montana Access to Health (MATH) web portal, you meet the requirements of the policy and no additional documentation is needed. Providers who currently receive paper checks and/or paper remittance advices must follow the process below to transition to EFT and ERAs.

Forms Needed

To sign up for EFT (direct deposit) and register for the web portal, providers need to complete the documents listed below and mail or fax them to Provider Relations (see next page). See the Provider Enrollment webpage for the needed documents. A letter from your financial institution verifying legitimacy of the account is also required. The letter must include the name and contact information of the bank representative and be signed by the bank representative.

  • Montana Medicaid Electronic Funds Transfer (EFT) & Electronic Remittance Advice (ERA) Authorization Agreement
  • Trading Partner Agreement
  • Letter from your financial institution verifying the routing number and account number. The letter must include the name and contact information of the bank representative and must be signed by the bank representative. Do not send voided checks or deposit slips.

EFT Instructions

To enroll in EFT, a provider must complete and sign the EFT & ERA Authorization Agreement and mail or fax the Agreement and the financial institution letter to provider Relations.

Upon receipt of the form, Provider Relations adds the EFT information to the provider’s profile. This process takes up to 10 business days. Once completed, the provider will get paid via EFT on the next payment cycle.

ERA Instructions

To receive ERAs, a provider must complete the Trading Partner Agreement (TPA) and register on the MATH web portal to view the ERAs.

  1. The provider prints, completes, and signs the TPA. The provider must include his/her NPI/API on the last page of the TPA.
  2. The provider faxes or mails the TPA to Provider Relations. Once Xerox receives the TPA, the process takes up to 10 business days.
  3. Xerox mails the Welcome Letter to the provider. This letter contains the credentials to register for the web portal (user ID and password) and the provider's submitter ID.
  4. Providers can then register online using the information provided in the Welcome Letter. Click the Log in to Montana Access to Health link at the top of this page. You may also want to reference the web portal tutorials: Web Portal Registration and Web Portal Navigation. Note: Upon registering, providers are notified via e-mail that they must change their password and have 24 hours to do so.
  5. Once registered, the provider must access Manage Users and Update or Remove Users and grant yourself Security Privileges following the instructions given. Providers must log out and back in for the privileges to take effect.
  6. To access a remittance advice (in PDF format), click on Retrievals and View e!SOR Reports.

Mail or fax enrollment documents to Provider Relations:

Provider Relations
P.O. Box 4936
Helena, MT 59604
406-442-4402 (Fax)

Providers may also request an 835 ERA delivered to their clearinghouse.

Please contact your clearinghouse or software vendor to begin that process.


Personal Assistance Services/Community First Choice Mass Adjustment
Community Services Bureau and Xerox are working to adjust claims coded as Personal Assistance Services (PAS) to be coded as Community First Choices (CFC) claims. This change is for reporting purposes only. The claims were paid correctly when they were processed; however, the data was not captured as a CFC claim until August 2014.

Accurate reporting of the CFC claims data is required for Department reports submitted to the Centers for Medicare and Medicaid Services (CMS). Because CFC was implemented in July 2014 and made retroactive to October 2013, all CFC claims that were received without the CFC indicator will be adjusted weekly until all claims have been adjusted.

These claims will remain in a pending status until the edit has been completed. Although it is expected that most claims will be resolved and you will not see any activity on your remittance advice, some claims may be delayed, and you will have a deduction or credit balance on your remittance advice for the week.

When the claim is resolved, the amount of the claim will be returned as a CFC claim. If you have questions, please call Provider Relations at 1-800-624-3958.

Elective Deliveries

Effective October 1, 2014, Montana Medicaid will reduce reimbursement rates for non-medically necessary inductions prior to 39 weeks, and non-medically necessary Cesarean sections at any gestational ages.

All hospital claims with an admit date on or after October 1, 2014, and delivery claims with a delivery date on or after October 1, 2014, will require coding changes.

Although the rate change is not effective until October, Montana Medicaid will begin accepting these changes to claims on or after July 1, 2014.

For more information, see the applicable provider notice:


Electronic Files Reloaded in Error
On 05/21/2014 there was an  inadvertent reloading of several electronic 837I files from 2013.  This affected approximately 1,700 claims.

These claims will  appear on your remittance advices as duplicate denials. If any claims paid again in error, an adjustment will be done to take monies back. We apologize for any inconvenience this may have caused. (PD05232014)

Important Information Regarding CMS-1500

As of April 1, 2014, the CMS-1500 (08/05) is no longer a valid form for the submission of professional claims. Providers must use the CMS-1500 (02/12) claim form for submission of Medicaid claims for payment.  

See the Claim Jumper for information about billing with the 02/12 version and reference the guideline developed by the National Uniform Claim Committee at www.nucc.org. (PD04112014)

Retroactive Eligibility
Effective January 1, 2014, providers must use the Notice of Retroactive Eligibility (160-M) if a member has been determined retroactively eligible. The FA-455 and FA-454 will no longer be accepted.

Providers should attach the Notice of Retroactive Eligibility (160-M) when submitting claims for retroactively eligible member for which the date of service is more than 12 months earlier than the date the claim is submitted. Claims without the Form 160-M will not be paid.

Contact the member’s local Office of Public Assistance to request the form. See http://www.dphhs.mt.gov/contactus/humancommunityservices.shtml. (PD042014)

Using Medicaid Card ID for Billing and Checking Eligibility
Providers should use the Medicaid member ID number, not the member’s Social Security number (SSN), for billing purposes and checking eligibility.

This ensures the expenditures are applied to the correct member and any query information is for the correct member. Errors can occur using the SSN for either billing or requesting eligibility information.

If you only have the member’s SSN, have questions, or need assistance, contact Provider Relations at 1.800.624.3958 or via e-mail at MTPRHelpdesk@xerox.com. (PD012014)

Medicare/Medicaid Remittance Advice Reminder and Adjustments
If you need to do an adjustment, and you are using a Medicare Remittance Advice Template to print your Medicaid Remittance advice, be aware that not all templates will  accommodate the necessary Medicaid information to allow your adjustment to process. 

The issue is the length of the ICN that appears on the Medicare Remittance Advice Template.

The Medicare ICN is formatted for 15 digits but the Medicaid ICN length is 17 digits. This will truncate the Medicaid ICN by 2 digits.

Please check this field and make any necessary corrections. If this is not corrected, we will return your adjustment to you for correction.

Drug and Pharmacy News

EOB Reason and Remark Crosswalk
An updated version of the EOB Reason and Remark crosswalk, which matches the HIPAA standard R&R codes to the Medicaid EOB codes, is posted under Other Resources in PDF and Excel format on each provider page.

Eligible Drug Manufacturers
Montana Medicaid reimburses only for drugs that are manufactured by companies that have a signed rebate agreement with CMS. An updated list of these manufacturers is available at the link and on appropriate provider pages. To determine if a manufacturer has signed a rebate agreement, check the first 5 digits of the National Drug Code (NDC) against the list. If there is no match, the drug is not reimbursable.

The list will be updated quarterly, so please check regularly to assure coverage. In addition, the valid NDC must be recorded on the claim (no spaces, no punctuation) as an 11-digit series of numbers. Claims will be denied for drugs billed without a valid 11-digit NDC. Providers also must be careful when entering the NDC quantity (the administered amount). A list of the most commonly used NDCs is available for providers. For more information on billing with NDCs on a CMS-1500, refer to the provider notice dated April 10, 2008. For more information on billing with NDCs on a UB-04, refer to the provider notice dated September 1, 2009.

Medicare Part D Prescription Drug Benefit News

Introduction to Medicare Part D Drug Benefits

Need help with picking the right Part D plan for you or your member?

Stand-Alone Prescription Drug Plans Eligible to Receive Auto-Enrolled Beneficiaries in Montana

The WellPoint Point of Sale system for dual-eligible Medicare and Medicaid eligible individuals:

  • Point of Sale Facilitated Enrollment of Dual Beneficiaries for Pharmacists
  • Point of Sale Facilitated Enrollment of Dual Beneficiaries Tip Sheet

Learn About the Medicare Prescription Drug Plan

  • Medicare Prescription Drug Coverage Personal Information Worksheet for People with Medicare and Medicaid
  • Choosing a Medicare Drug Plan for People with Medicare and Medicaid
  • People with Medicare and Medicaid: Medicare will enroll you in a plan automatically. How do you find out which plan?
  • Request for Prescription Information or Change. This is a standard form for exceptions or prior authorizations.

Medicaid Program Information Handbook insert. Learn more about Medicaid coverage of prescription drugs for members who are dual eligible for both Medicare and Medicaid.


Tamper-Resistant Prescription Pad Vendors

Get up-to-date Montana Medicaid preferred drug information! Visit the Pharmacy provider page for a list of preferred drugs and upcoming Montana Medicaid and Medicaid Mental Health Drug Use Review Board/Formulary Committee Meetings.

For more information on Montana Prescription Drug Assistance Programs, including help with Medicare Rx premiums, visit Big Sky Rx.

Electronic Billing

Electronic Billing Website Links Updated
The Xerox EDI Solutions website (formerly ACS EDI Gateway) has changed. For Montana Medicaid, click on the EDI Solutions Clients tab and choose Montana Department of Public Health and Human Services.

WINASAP 5010 software can be found under the WINASAP tab. EDI enrollment information is available on the EDI Enrollment page. If you are having trouble finding information, contact Provider Relations 1.800.624.3958.

Health Improvement Program (HIP)

Montana Medicaid Health Improvement Program
The Health Improvement Program for Medicaid and HMK Plus members with chronic illnesses or risks of developing serious health conditions. HIP is operated through a regional network of 14 community and tribal health centers. Medicaid and HMK Plus members eligible for the Passport Program are enrolled and assigned to a health center for possible care management.

Instructions and Provider Referral Form (10/2014)

ICD-10 Information

Meeting Timelines for ICD-10

For detailed timelines of activities that providers, payers, and vendors need to undertake to prepare for ICD-10, download the timeline widget to your desktop or mobile device.

Printer-friendly versions of the ICD-10 widget compliance timeline is available for large providers, small providers, payers and vendors.

The widget and timelines are public domain. CMS encourages organizations to distribute them widely through posting to websites and other channels.

For information about ICD-10, see the link in the menu on the left.

Navigation Assistance

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Website Tips
For tips on using this website or to download frequently requested resources (such as how to verify member eligibility, Medicaid covered services, important contacts, and more), see the Medicaid Information option in the menu on left.

Provider File and NPI Information

Provider File Updates
If a provider needs to update their provider file (e.g., change of practice location, billing address, tax information), mail the information to Provider Relations, P.O. Box 4936, Helena, MT 59604 or fax to 406.442.4402, Attention: Provider File Updates.

NPI Required for Eligibility Verification
Providers must use their NPI when inquiring about member eligibility using FaxBack, the Voice Response system or the MATH web portal.

If you have questions, call Provider Relations at 1.800.624.3958.

Tribal, Urban, and Indian Health Services

Montana Medicaid strives to provide programs and improve billing capacity within our Tribal, Urban, and Indian Health Service clinics.

DPHHS is committed to improving the health of Montana’s Indian population. Every third Wednesday of the month, Tribal, Urban and IHS clinics discuss billing issues for Indian country with Medicaid staff for distinct sets of billings instructions and claims issues.

Everyone is welcome. Staff from the Montana Medicaid Program and Xerox State Healthcare, LLC, will all be available to answer questions and streamline the billing process.

Our goal for these calls is to improve communication and keep an ongoing conversation revolved around billing, so everyone has the correct information.

For Tribal, Urban, or Indian Health Service billing questions contact:
John Hein, Medicaid Program Officer, 406.444.4349 or JHein@mt.gov
Lesa Evers, Tribal Relations Manager, 406.444.1813 or LEvers@mt.gov

Additional resources are available on the IHS page.