Montana Medicaid Provider Information

WHAT'S NEW ON THE SITE THIS WEEK

2010 Provider Fair
The 2010 Provider Fair has been scheduled for April 6-7 at the Gateway Center in Helena, MT. For a registration form and schedule of events, visit the Upcoming Events page.

Holiday eSOR and Payment Schedule
Due to the Martin Luther King, Jr. holiday, Electronic Statements of Remittance (eSORs) and payments that providers are expecting to see on Monday, January 18, may be delayed.

New Eligibility System to be Implemented October 1
DPHHS' new eligibility system, the Combined Health Information and Montana Eligibility System (CHIMES), will be implemented October 1. Please continue to follow your usual procedures for verifying eligibility each time a Medicaid patient visits your office for services. Contact your local OPA office for assistance with eligibility issues.

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 of www.mtmedicaid.org.

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.

New Inpatient Reimbursement Begins October 1, 2008
On October 1, 2008, the Montana Department of Public Health and Human Services implemented a new inpatient payment methodology based on All Patient Refined Diagnosis Related Groups (APR-DRGs). Effective for claims with first date of service October 1, hospitals must follow new billing requirements and will be paid under the new method. Any claims with an October admission date received in the first several weeks of October will be paid using the previous method and then automatically adjusted by ACS. All hospitals will continue to receive payments weekly during this transition period. For more information, visit the New APR-DRG Payment Method page.

CHIP Claims Processing Change for Most Extended Mental Health Services
 Effective October 1, 2008, Blue Cross and Blue Shield of Montana (BCBSMT) will process claims for the CHIP Extended Mental Health Plan for Children with a Serious Emotional Disturbance (SED). There is one exception. Community Based Psychiatric Rehabilitation and Support (CBPRS - code H2019) will continue to process through Affiliated Computer Services (ACS). All Extended Mental Health claims for dates of service prior to October 1, 2008, will continue to process through ACS.

The claims processing change is made to incorporate the majority of CHIP mental health related benefits under the program’s current third party administrative contractor, BCBSMT. This change will address providers’ concerns related to claims processing for CHIP Extended Mental Health benefits.

Federal Government May Request Medical Records
Beginning October 1, 2007, Montana’s Healthcare Plans will be required to participate in the federal Payment Error Rate Measurement (PERM) program. This national program will measure improper payment in Medicaid and CHIP because these two programs were identified as being at risk for significant erroneous payments. Providers will be asked to send copies of selected claims to a CMS contractor for review. Click here for more information.

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's Healthcare 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 Reenrollment and Billing
All providers who wish to bill any of Montana’s Healthcare Programs—Medicaid, Children’s Health Insurance Plan (CHIP)-Dental and Eyeglasses Services Only, and Mental Health Services Plan (MHSP)—are required to complete the reenrollment process. Instructions for NPI reenrollment and billing can be found here. Updated Frequently Asked Questions can be found here.

National Drug Code Billing Instructions
The Federal Deficit Reduction Act of 2005 mandates that all State Medicaid Programs require the submission of National Drug Codes (NDCs) on claims submitted with certain procedure codes for physician-administered drugs. This mandate affects all providers who submit claims for procedure-coded drugs both electronically and manually. Instructions for billing NDCs can be found here.

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.

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.

Online Reenrollment for NPI Available
On-line reenrollment is available through Montana Access to Health.

NPI Paper Reenrollment Form 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.

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. (Updated 12/10/09)

For more information on Montana Prescription Drug Assistance Programs, including help with Medicare Rx premiums, visit www.bigskyrx.mt.gov.

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