Montana Medicaid Provider Information
WHAT'S NEW ON THE SITE THIS WEEK
Noridian Merger to Affect
COBA Trading Partners
CMS is alerting providers that Noridian Administrative Services (NAS)
is in the process of merging six Medicare claims processing environments,
including Montana, effective May 1, 2008.
Noridian will impose dark days on May 1 and 2, during which the contractor will not transmit crossover files to the COB Contractor (COBC). Monday, May 5, will be Noridian's first claims cycle date, and, at that time, Noridian will resume transmission of crossover files to the COBC.
Read the entire notice here.
May 7 Is “Legacy Free” Day
– An Opportunity to Check Your NPI Readiness!
CMS, in collaboration with the Healthcare Information
and Management Systems Society (HIMSS), has requested clearinghouses that
submit claims to FFS Medicare to participate in a one-day NPI preparation
exercise. Specifically, on Wednesday, May 7, 2008, participating clearinghouses
should submit Medicare claims with NPI-only in all provider identifier
fields for which a provider uses NPI/legacy pairs. On May 8, participating
clearinghouses will revert back to sending Medicare NPI/legacy pairs as
received from the providers.
Through its monthly NPI messages, CMS has been requesting providers to begin testing NPI-only by sending a group of claims with NPI alone in primary provider fields. This “exercise” will result in feedback from your Medicare contractor on your readiness as it pertains to your National Provider Identifiers.
On May 7, 2008, participating clearinghouses will send Medicare claims with NPI-only in provider fields which originally contain NPI/legacy pairs from the provider. In other words, clearinghouses will strip the legacy identifiers when they are submitted as part of an NPI/legacy pair. Of course, fields already containing NPI-only will be sent to Medicare, as usual, and secondary provider identifier fields containing legacy-only will be sent to Medicare, as usual.
AVRS/FaxBack Functionality
Enhanced
AVRS/FaxBack has been enhanced to allow providers with multiple enrollments
and different fax numbers for one NPI to verify eligibility. Providers
can also complete eligibility inquiries on the MATH
web portal. If you have any questions, please contact ACS Provider
Relations at 1-800-624-3958.
Providers May Receive Paper
Checks
Due to a system error, providers who were expecting electronic payment
transfer this week may receive paper checks instead. Electronic payments
should resume next week as usual.
NPI Reenrollment and Billing National Drug Code Billing Instructions NPI and Taxonomy Electronic Claim
Instructions NPI and Taxonomy Paper Claim Instructions |
Possible Duplicate Claims Processed Through
Electronic Data Interchange
ACS has discovered that beginning January 6, 2008, the electronic data
interchange has been creating multiple files for claims submission to
the Medicaid Management Information System. This issue will create multiple
claims for the same service. These multiple claims will result in an
increased number of exact duplicate denials showing on providers’
remittance advices. This issue will not result in incorrect payment,
but it will result in an increased number of denied claims on remittance
advices. This issue was corrected on January 16 and processes have been
put in place to prevent it in the future.
Passport to Health Caseloads to Increase
In the next several months, Passport
providers will see an increase in their Passport client caseload. This
means an increase in case management fees paid to providers. Providers
who want new clients enrolled should ensure that their caseload limit
is higher than zero or one. Due to system changes during the past year,
providers will not be automatically assigned clients if their current
caseload is higher or equal to the amount they chose in their Passport
contract. Providers who do not know their caseload limit should call
the Passport help line at 1-800-362-8312 from 8 a.m. to 5 p.m. Monday
through Friday. Representatives can assist them in increasing their
limit. For more information, please read the entire
provider notice.
Institutional Providers Must Use NPI
to Check Eligibility on the Web Portal After January 1, 2008
All old institutional provider numbers will no longer be valid to check
eligibility. These numbers can still be used to check claim status.
If providers do not see their NPI numbers in their drop-down box on
the web portal, they will need to e-mail the submitter number and NPI
numbers to MTPRHelpdesk@acs-inc.com.
Pharmacy Lockin for Team Care Clients
The pharmacy lockin provider is reporting incorrectly for Team Care
clients. We are working on the issue. If you need lockin pharmacy information,
please call Provider Relations at 1-800-624-3958.
Providers May Receive Paper Checks
Providers who have re-enrolled with Montana's Healthcare
Programs and have signed up for direct deposit may receive a paper check
for one or two payment cycles due to issues related to the large volume
of requests. We are working on the problems and hope to have them resolved
quickly.
MATH Web Portal Now Accessible
Problems with the Montana Access to Health web portal have been resolved
and the site is available for provider use. However, the Medical History
function is not yet working. We apologize for any inconvenience and will
post notification here when Medical History is available.
Billing Montana Healthcare Programs
Medicare recently announced that they will continue to allow providers
to bill using their legacy number only. Medicare is also allowing providers
to bill using their NPI number only or both their NPI and legacy number.
Due to Medicare’s decision, Montana Healthcare Programs will also
allow providers to bill Medicaid using their NPI (for healthcare providers);
NPI and current Montana Healthcare Program number(s) or their current
Montana Healthcare Programs number(s). When Medicare mandates NPI-only
billing for healthcare providers, Montana’s Healthcare Programs
will also require the NPI. For atypical providers, they may use their
new Montana Healthcare Program number.
There is a possibility that you may receive more than one payment from Montana’s Healthcare Programs if you bill Medicare differently than you bill Montana’s Healthcare Programs.
- If you bill Medicare using your NPI and Montana’s Healthcare Programs with your current provider number, your crossover payment will be under your NPI and payment for non-Medicare claims will be under your current number.
- If you bill Montana’s Healthcare Programs using your NPI and Medicare with your current Medicare legacy number, your crossover payment will be under your current Montana Healthcare Program number and your non-crossover claims will be under your NPI.
For claims received on or after October 1, 2007, the Department of Public Health and Human Services encourages providers who have an NPI or have been issued a new atypical provider number to use these numbers to bill. If you have received your NPI and are not yet reenrolled in Montana’s Healthcare Programs, you are encouraged to do so immediately. Reenrollment is available online at www.mtmedicaid.org. For those providers who do not yet have an NPI, you may apply online at https://nppes.cms.hhs.gov.
If you have questions or need assistance with reenrollment, contact ACS Provider Relations at 1-800-624-3958.
Certificate Issue on the Web Portal
The secure web portal is displaying a security warning regarding its certificate.
The portal remains secure and all transmissions are encrypted. The certificate
is being renewed and the message will be cleared once that is complete.
Attention New Providers
If you are enrolling for the first time in Montana’s
Healthcare Programs, which include Medicaid, Children’s Health
Insurance Program (CHIP) and Mental Health Services Plan (MHSP), please
note the following.
This enrollment will not be effective to use for billing until October 1, 2007. Services provided prior to October 1 can be billed after October 1. When completing the web enrollment, the effective date of your enrollment is the date you indicate on the enrollment that you first provided services to a Montana's Healthcare Program client.
If you must bill for services prior to October 1, complete and submit
the web enrollment and contact Provider Relations at 1-800-624-3958.
NPI on the Web Portal
While providers may now include their NPI on their claims, they should
continue to select their current Medicaid provider number from the drop-down
menus when using the MATH web portal. The NPI number may appear as an
option, but selecting it will cause the provider to receive an error.
NPI numbers will be used beginning October 1, 2007.
Instructions for Billing on Paper During
the NPI Contingency Period
Providers billing Montana's Healthcare Programs on either the new
CMS-1500 or UB-04 must follow these
specific instructions until the end of the contingency period.
Billing During the NPI Contingency Period
A National Provider Identifier (NPI) contingency plan has been
put in place, changing the NPI implementation date for Montana’s
Healthcare Programs operated by ACS. This contingency plan affects how
providers must complete claims submitted between now and the end of the
contingency period. Click
here for more information.
Online Reenrollment for NPI Now Available
On-line
reenrollment is now available through Montana Access to Health.
As of March 2, only providers without Internet access will be allowed
to complete a paper application
NPI Paper Reenrollment Form Now Available
The new paper form is available for current providers to begin the reenrollment
process to capture NPI numbers and update information within the provider
system. This reenrollment form can be downloaded at Existing
Provider Reenrollment for Participation On or After October 1, 2007.
Remittance Advice Files on the Web Portal
Beginning Thursday, January 25, providers
who have online remittance advice (RA) files with more than 1,000 pages
will receive multiple numbered files instead of one large file. If you
have questions about your RAs, please contact Provider Relations.
Provider Reenrollment for NPI
Effective February 1, 2007, providers
began the reenrollment process by downloading the revised paper enrollment
forms, completing them and mailing them to ACS. Reenrollment utilizing
the web became available March 1, 2007. Institutional providers must
ensure that reenrollment is completed prior to January 1, 2008, and
professional providers prior to March 1, 2008, to continue to be reimbursed
by Medicaid. Only providers that do not have access to the Internet
may use the paper enrollment option after March 1, 2007.
Montana Access to Health
Web Portal
More improvements made to Web Portal! We
recently made the following improvements to the Web Portal:
- Claim Status now returns only claims on which both the begin and end date of service are considered and sorts claims returned by date of service instead of claim status and then date of service. In addition, if a patient account number is present, it is reported.
- Medical History now offers a "back to" button that returns the user to the Medical History Inquiry and an "uncheck all" feature on the inquiry that allows users to click on "all claim types" to uncheck all boxes instead of unchecking each one individually.
Montana Access to Health tutorial. Learn how to verify Medicaid eligibility, check claim status, determine warrant amount, review medical history, upload and download files online, update user information, and more.
Provider Satisfaction
Please complete our Provider
Satisfaction Survey. Let us know how we're doing!
Medicare Part D Prescription Drug Benefit
News
Medicare
Part D Prescription Drug Benefit News
Request for
Prescription Information or Change. This is a standard form for
exceptions or prior authorizations.
The Wellpoint system for dual-eligible individuals:
- Point of Sale Facilitated Enrollment of Dual Beneficiaries
- Q & A
- Point of Sale Facilitated Enrollment: Update on NACDS Issues, Wellpoint/CMS
Stand-Alone
Prescription Drug Plans Eligible to Receive Auto-Enrolled Beneficiaries
in Montana
Help Your Clients 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?
- Medicaid Program Information Handbook insert. Learn more about Medicaid coverage of prescription drugs for clients who are dual eligible for both Medicare and Medicaid.
Passport to Health
ACS to Assume Passport To Health Functions
Beginning June 4, 2007, ACS will again be partnering with the Department
of Public Health and Human Services to manage the Passport To Health
program. ACS will be responsible for Passport enrollment and the Client
Help Line. This change will help streamline the program for the Department
and providers by having one entity responsible for both provider and
client relations.
Contact information for Passport questions (including enrollment, contract and caseload changes) remains the same:
Passport To Health
P.O. Box 254
Helena, MT 59624
1-800-362-8312
For all other Medicaid billing or claim questions, please continue to contact ACS Provider Relations at 1-800-624-3958.
Pharmacy
Tamper-Resistant
Prescription Pad Vendors
Get the Most Recent 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. (Updated 04/21/08)
For more information on Montana Prescription Drug Assistance Programs, including help with Medicare Rx premiums, visit www.bigskyrx.mt.gov.
Website Tips
For tips on using this website or to download frequently requested resources
(such as how to verify client eligibility, Medicaid covered services,
important contacts, and more), select Website
Tips or Medicaid Information from the menu on the left.
Do you have Adobe Reader?
Most documents on this website require Adobe Acrobat
Reader. Click below to download Adobe Reader for free.
