Montana Medicaid Provider Information

WHAT'S NEW ON THE SITE THIS WEEK

MATH Web Portal and Production HIPAA 5010 Files

Attention All Providers: For those of you who use the MATH web portal to upload 837P, 837D, 837I, 270, or 276 batch transactions, the functionality is now available for production HIPAA 5010 files. The corresponding 999, 277CA, 271, and 277 response files can also be retrieved on the MATH web portal. We apologize for the delay in making this functionality available.

All other submission methods continue to be available for both HIPAA 4010 and 5010 files. Montana Health Care Programs will accept these transactions in the HIPAA 4010 format through December 31, 2011, but beginning January 1, 2012, transactions submitted in the HIPPA 4010 format will no longer be accepted through the MATH web portal or any other submission method.

Please contact ACS Provider Relations at 1-800-624-3958 or 442-1837 if you have any questions or have problems submitting or retrieving files.

Provider Fair 2012 Survey

Click on the link below for your opportunity to assist with development of the sessions to be offered at the Provider Fair. Your input is important to ensure the trainings are beneficial and provide the information necessary for your participation in Montana Health Care Programs. Take the Survey.

HIPAA 5010 Update

Montana Health Care Programs began accepting production 5010 transactions on December 1, 2011.

All 5010 transactions (837I Health Care Claim: Institutional, 837P Health Care Claim: Professional, 837D Health Care Claim: Dental, 270 Eligibility Inquiry Status and 276 Claim Inquiry Status) received between December 1, 2011 and December 7, 2011, were released for processing on December 7, 2011.

If you submit 5010 transactions between December 1 and December 7, 2011, and have not received the appropriate response files (999 Implementation Acknowledgment, 277CA Claim Acknowledgement, 271 Eligibility Inquiry Response or 276 Claim Status Response) contact ACS Provider Relations.

Claims submitted electronically were processed through MMIS on December 7. Transactions submitted after December 7 will be processed immediately upon receipt.

All electronic transactions must be submitted in the 5010 format on and after January 1, 2012; any transactions submitted in the 4010 format on or after this date will not be processed.

Contact ACS Provider Relations (800-624-3958 or 406-442-1837) if you have any questions.

Remittance Advice Delay
Due to technical issues, payments and remittance advices will be delayed until Tuesdays each week. Notification will be posted here when they are once again available on Mondays.

IVR Technical Issue
We are currently experiencing a technical issue with the payment summary information through the IVR.

If you have multiple enrollments under one NPI, and you use the automated provider inquiry system for payment summary information, you may not receive accurate payment summary information for each enrollment. We are working on the issue and anticipate that we should be able to return all payment summary information soon.

To receive the most accurate payment summary information through the IVR, please use your 7-digit provider identifier. This number appears on your remittance advice as the vendor number immediately above your NPI. To use this number in the IVR, please enter only the last 7 digits. If you cannot locate your vendor number, contact Provider Relations for assistance.

As always, for payment summary information you may call Provider Relations at 1-800-624-3958 or visit the Montana Access to Health web portal.

Meeting Timelines for ICD-10 and HIPAA 5010
For detailed timelines of activities that providers, payers, and vendors need to undertake to prepare for Version 5010 and ICD-10, download our timeline widget to your desktop or mobile device.

Printer-friendly versions of the Version 5010 and ICD-10 widget compliance timelines are 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.

Payment Error Rate Measurement (PERM)
Beginning October 1, 2011, Montana Health Care Programs will be required to participate in the federal PERM program.

This national program will measure improper payment in Medicaid and HMK because these two programs were identified as being at risk for significant erroneous payments. Providers will be asked to send copies of selected claims and medical records to a CMS contractor for review.

See the provider notice dated September 7, 2011, for more information.

Montana Medicaid Health Improvement Program
Montana has a new Health Improvement Program for Medicaid and HMK Plus patients with chronic illnesses or risks of developing serious health conditions. The Health Improvement Program will be operated through a regional network of Community and Tribal Health Centers. Medicaid and HMK Plus patients eligible for the Passport Program are enrolled and assigned to a health center for possible care management. Instructions and a provider referral form can be found here.

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

Electronic Billing Website Links Updated
The ACS EDI Gateway website has been redesigned and links to it have changed. Companion Guides can be found under the EDI Gateway Clients tab by choosing Montana DPHHS. WINASAP2003 software can be found under the WINASAP2003 tab. In addition, EDI enrollment forms are now available on the Forms and Electronic Billing pages (see menu on left).

If you are having trouble locating EDI information, please contact Provider Relations.

List of Eligible Drug Manufacturers Updated
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 has been posted on www.mtmedicaid.org under "Rebateable Manufacturers" on the appropriate provider pages. To determine if a manufacturer has signed a rebate agreement, check the first five 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.

 New End User Agreement for Providers
Much of the provider information contained on the Montana Medicaid website is copyrighted by the American Medical Association and the American Dental Association. This includes items such as CPT codes and CDT codes. Before you can enter the Resources by Provider Type section of the site, you now will be required to read and accept an agreement to abide by the copyright rules regarding the information you find there. If you choose not to accept the agreement, you will return to the Montana Medicaid home page. If you have questions about this agreement, please call Provider Relations at 1-800-624-3958.

Transferring Credit Balances
Now that claims are being processed with either National Provider Identifier (NPI) or atypical provider identifier (API), any activity on your previous legacy provider number may result in that number moving into a credit balance. Your legacy number may move in and out of a credit balance depending on adjustments completed to claims originally billed with the legacy number.

ACS has started moving the credit balance amounts from your legacy number to the NPI/API and will continue to do so until all currently enrolled providers are no longer in a credit balance. This process will take a significant amount of time due to the number of providers involved. If you wish to have your credit balance moved more quickly, please contact Provider Relations and ask to have your credit balance moved to your NPI/API. You will need to indicate the legacy number from which you wish the credit moved and the NPI and taxonomy or API to which you wish the credit moved. These transactions are conducted as gross adjustments and cannot be attributed to any individual client.

When the credit is satisfied, those claims that appeared in the credit balance section of your remittance advice will move into the paid section and can be posted at that time.

Provider File Updates
Providers who have already completed their reenrollment with Montana Health Care Programs in conjunction with the implementation of NPI do not need to complete a new enrollment if their information changes. If a reenrolled provider needs to update their provider file (i.e., change of practice location, billing address, tax information, etc.), they should mail the new information to Provider Relations, P.O. Box 4936, Helena, MT 59604 or fax to (406) 442-4402, Attention: Provider File Updates. Health care providers who have not yet reenrolled with their NPI, or atypical providers for a new proprietary ID, should do so immediately.

NPI Required for Eligibility Verification
 Providers must use their NPI when inquiring about client eligibility using FaxBack, the Automated Voice Response System (AVRS), or the web portal. If you are not yet enrolled with your NPI, please call Provider Relations at 1-800-624-3958.

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 client?

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:

Learn About the Medicare Prescription Drug 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.

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.

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 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.

back to top