Montana Medicaid Provider Information

WHAT'S NEW ON THE SITE THIS WEEK

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.

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.

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.

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 and Taxonomy Electronic Claim Instructions
Providers who have an NPI can now bill using that number and their taxonomy. Institutional providers must bill with their NPI and taxonomy beginning January 1, 2008. Instructions for billing electronically using NPI and taxonomy can be found here.

NPI and Taxonomy Paper Claim Instructions
Providers who have an NPI can now bill using that number and their taxonomy. Institutional providers must bill with their NPI and taxonomy beginning January 1, 2008. Instructions for completing the new CMS-1500 using NPI and taxonomy can be found here. Instructions for completing the new UB-04 forms using NPI and taxonomy can be found here.

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.

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.

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.

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.

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.

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:

Stand-Alone Prescription Drug Plans Eligible to Receive Auto-Enrolled Beneficiaries in Montana

Help Your Clients Learn About the Medicare Prescription Drug Plan:

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.

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