Claim Instructions

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.

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.