Montana Medicaid Provider Information
WHAT'S NEW ON THE SITE THIS WEEK
Holiday eSOR Schedule
Due to the July 4th holiday, Electronic Statements of Remittance (eSORs)
will be posted to the website on Tuesday afternoon, July 7. Payments also
will be delayed by one day.
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). For more information
on billing with NDCs, refer to the provider
notice dated April 10, 2008.
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 National Drug Code Billing Instructions NPI and Taxonomy Electronic Claim Instructions NPI and Taxonomy Paper Claim Instructions |
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 BenefitsNeed help with picking the right Part D plan for you or your client?
- State Health Insurance Assistance Program (SHIP) 1-800-551-3191 or visit their Website at http://www.dphhs.mt.gov/sltc/services/aging/ship.shtml
- 1-800-MEDICARE (1-800-633-4227) or Medicare.gov
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 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 06/22/09)
For more information on Montana Prescription Drug Assistance Programs, including help with Medicare Rx premiums, visit www.bigskyrx.mt.gov.
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(such as how to verify client eligibility, Medicaid covered services, important
contacts, and more), select Website Tips
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