Montana Medicaid Provider Information

WHAT'S NEW ON THE SITE THIS WEEK

Electronic Health Records Link
The Electronic Health Records link will temporarily be under maintenance. An error message will display when you click on the link. If you need to access electronic health records during this time the Claims Based Medical History link will still be available.

If you have questions about Electronic Health Records or the Web Portal, please call provider relations 1-800-624-3958. Once again we apologize for the inconvenience and welcome any questions you may have.

Provider Training for Fall 2010
Montana Health Care Programs Fall provider training will be in Billings on September 29 & 30, Missoula on October 6 & 7, and Great Falls on October 13 & 14. Day one will focus on Billing Basics and include topics such as verifying eligibility, claims basics including electronic claims, special forms, preventing denials, website and web portal, SURS, TPL and Medicare. Day two will consist of presentations from State staff. A complete schedule for the fall training will be available on the website under “Upcoming Events”.

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.

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.

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 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.

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 04/08/10)

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.

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