Montana Medicaid Provider Information
Web Postings
A list of the documents posted to the provider website for the current week.
Effective July 1, 2013, EFT Users Must Receive Electronic RAs, Not Paper Until the provider enrollment forms have been updated to reflect the policy change, Provider Relations will monitor enrollment forms for paper remittance advice requests, and will notify the affected providers. |
DPHHS Medicaid and Non-Medicaid Provider Rate Increase Rule Hearing Effective July 1, 2013 The proposed new rates referenced in these rules reflect an approximate 2% provider rate increase that will be effective July 1, 2013. The proposed new fee schedule/rates for Developmental Disability Service providers are available on the Department website at http://www.dphhs.mt.gov/dsd/ddp/ddprateinformation.shtml. The proposed fee schedule/rates for all other providers are posted on the website; however, you must access and agree to the End User Agreement to view them. Click to view the proposed fee schedules. In order to give more time for comment, the Department will be extending the public comment period until May 30, 2013, for these provider rate increase rules. |
- 01/2013 RBRVS Addendum
- 07/2012 RBRVS Fee Schedule, SFY 2013
Important Enrollment Information The current version is available on the Provider Enrollment page of the Montana Medicaid Provider Information website or by contacting Provider Relations at 1-800-624-3958 or 406-442-1837. If you have questions, or need information, please call Provider Enrollment at 1.800.624.3958. |
HIPAA Rule Change Because of this rule, enhancement files that were submitted between March 25 and March 26 that did not meet this guideline were rejected. These changes affected ANSI X12 5010 claim types 837I, 837P, and 837D. This issue was discovered on March 26, 2013, and Xerox immediately asked to have this edit relaxed. The edit has been relaxed, and claims that have been submitted as of March 27, 2013, will not be rejected for line level description missing. No timeline has been set for this edit to go back into use. When a date has been set, an announcement will be published on this page. Files that have been rejected due to this issue will need to be resubmitted by the provider/clearinghouse. We apologize for this inconvenience. You may begin to include these descriptions at any time. Having the description will not restrict the claims for making it through. This does not change the current process of sending in via paper documentation that is required to process a claim. If procedure codes you bill are on this list, you will need to contact your software vendor to make sure that line level description is available to you. If billing with WINASAP 5010, the line level description is on the Claim Line Tab and is called Line Level Description. The following are examples of acceptable terms for non-specific codes:
If you have questions, or need information, please call Provider Relations at 1.800.624.3958. |
Montana Medicaid HIPAA Operating Rules Upgrade For more information, see the provider notice dated February 14, 2013. Copayment amount may be less or exempt per Administrative Rules. Please refer to your Medicaid provider manual for additional information. |
Medicare/Medicaid Remittance Advice Reminder and Adjustments The issue is the length of the ICN that appears on the Medicare Remittance Advice Template. The Medicare ICN is formatted for 15 digits but the Medicaid ICN length is 17 digits. This will truncate the Medicaid ICN by 2 digits. Please check this field and make any necessary corrections. If this is not corrected, we will return your adjustment to you for correction. |
Payment and Remittance Advice Payments and remittance advices are available on Tuesday of each week. |
Reminder for Providers If you are unsure whether you are using the correct form, contact Provider Relations at 1‑800‑624‑3958 or 406‑442‑1837. You may also access forms on the Medicaid Provider Information website (Forms page). When calling Provider Relations for any reason, please have your information (e.g., NPI, claim information) on hand before you call, and have paper and pen available to note information provided to you during the call. |
Spring 2013 Provider Training
The agenda and registration links for the spring sessions are available on the Training page.
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, is posted under Other Resources in PDF and Excel format on each provider page.
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 is available at the link and on appropriate
provider pages. To determine if a manufacturer has signed a rebate agreement,
check the first 5 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.
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 member?
- 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.
For more information on Montana Prescription Drug Assistance Programs, including help with Medicare Rx premiums, visit www.bigskyrx.mt.gov.
Electronic Billing Website Links
Updated
The EDI Gateway website has been redesigned and links to it have changed. Click on the EDI Gateway Clients tab and choose Montana Department of Public Health and Human Services.
WINASAP5010 software can be found under the WINASAP5010 tab. In addition,
EDI enrollment forms are now available on the Forms and Electronic Billing pages.
If you are having trouble locating EDI information, contact Provider Relations (800-624-3958 or 406-442-1837).
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 Provider Referral Form.
HIPAA 5010 Update
Montana Health Care Programs began accepting production 5010 transactions on December 1, 2011.
All electronic transactions must be submitted in the 5010 format on and after January 31, 2012; any transactions submitted in the 4010 format on or after this date will not be processed.
Contact Provider Relations (800-624-3958 or 406-442-1837) if you have any questions.
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 the 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.
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 Provider Relations at 1-800-624-3958 or 442-1837 if you have any questions or have problems submitting or retrieving files.
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Website Tips
For tips on using this website or to download frequently requested resources (such as how to verify member eligibility, Medicaid covered services,
important contacts, and more), see the Medicaid Information option in the menu on left.
Crossover Claims
Xerox recently corrected an issue where the parent or spouse was found instead of the subscriber when the Medicare ID was sent as the subscriber
ID in Loop 2010BA, data element NM09 on COBA claims.
The change was implemented on 02/23/2012, so the correct member will be found when the Medicare ID is submitted on any 837P COBA files received on or after this day.
We apologize for any inconvenience and ask providers to resubmit any claims that denied due to this issue. If you are submitting the claim directly to Xerox, the subscriber must be the 7-digit card ID or the 9-digit SSN; the Medicare ID will only be used to find the correct client when the claim comes directly from COBA.
This issue did not affect 837I COBA crossover claims.
EPSDT Indicator Issue
We recently corrected an issue where the EPSDT indicator sent on the 837P
in Loop 2400, data element SV111 was not always captured.
This change was implemented on 02/23/2012, and the EPSDT indicator will be captured on any lines sent in 837P files on or after this day.
We apologize for any inconvenience and ask that providers resubmit any claims that denied or adjust any paid claims with denied lines or that had cost share taken incorrectly due to this issue.
Provider File Updates
Providers who have already completed their re-enrollment
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 re-enrolled 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 re-enrolled 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 member eligibility using FaxBack, the Voice Response system or the MATH web portal. If you are not yet enrolled with your NPI, please call Provider Relations at 1-800-624-3958.
Montana Medicaid strives to provide programs and improve billing capacity within our Tribal, Urban, and Indian Health Service clinics.
DPHHS is committed to improving the health of Montana’s Indian population. Every third Wednesday of the month, Tribal, Urban and IHS clinics discuss billing issues for Indian country with Medicaid staff for distinct sets of billings instructions and claims issues.
Everyone is welcome. Staff from the Montana Medicaid Program and Xerox State Healthcare, LLC, will all be available to answer questions and streamline the billing process.Our goal for these calls is to improve communication and keep an ongoing conversation revolved around billing, so everyone has the correct information.
For Tribal, Urban, or Indian Health Service billing questions contact:
John Hein, Medicaid Program Officer, 406-444-4349 or JHein@mt.gov
Ian McEwen, Tribal Medicaid Specialist, 406-444-6085 or IMcEwen@mt.gov
Lesa Evers, Tribal Relations Manager, 406-444-1813 or LEvers@mt.gov
Meeting Information
Minutes from the Tribal/IHS Teleconference May 15, 2013 Meeting
Minutes from the May 1, 2013 Urban Indian Clinic Meeting
Agenda June 5, 2013 Urban Indian Clinic Meeting
Additional resources are available on the IHS page.
