Hospital Outpatient
Provider Manuals (Updated April 25, 2006)
Medicaid Rules/Regulations (Updated May 9, 2006)
Fee Schedules (Updated August 5, 2008)
Notices and Replacement Pages (Updated August 12,
2008)
Other Resources (Updated January 2, 2008)
Remittance Advice Notice
Key Contacts (Updated March 1, 2007)
Provider
Manuals
General Information
For Providers
Medicaid billing manual with general information for all provider types.
04/2005
Hospital Outpatient
Services
This manual has billing instructions specific to your provider type.
12/2005
Critical Access
and Exempt Hospital Services
This manual has billing instructions specifically for critical access
and exempt hospitals.
01/2006
Passport
to Health Provider Handbook
Everything providers need to know to become a successful Passport provider.
09/2005
Medicaid
Rules/Regulations
Administrative
Rules of Montana (ARM)
Montana
Code Annotated (MCA)
Code
of Federal Regulations (CFR)
Fee
Schedules
July Fee Schedule
in PDF Format
08/2008
July Fee Schedule in Excel Format
08/2008
July APC Schedule in PDF Format
08/2008
July APC Schedule
in Excel Format
08/2008
April Fee Schedule
in PDF Format
05/2008
April Fee Schedule in Excel Format
05/2008
April APC Schedule in PDF Format
05/2008
April APC Schedule
in Excel Format
05/2008
January Fee Schedule
in PDF Format
03/2008
January Fee Schedule in Excel Format
03/2008
January APC Schedule in PDF Format
03/2008
January APC Schedule
in Excel Format
03/2008
October Fee
Schedule in PDF Format
11/2007
October Fee Schedule
in Excel Format
11/2007
October APC Schedule in PDF Format
11/2007
October APC Schedule
in Excel Format
11/2007
July Fee Schedule
in PDF Format
07/2007
July Fee Schedule
in Excel Format
07/2007
July APC Schedule in PDF Format
07/2007
July APC Schedule
in Excel Format
07/2007
April Fee Schedule
in PDF Format
06/2007
April Fee Schedule
in Excel Format
06/2007
April APC Schedule in PDF Format
06/2007
April APC Schedule
in Excel Format
06/2007
January Fee
Schedule in PDF Format
01/2007
January Fee Schedule
in Excel Format
01/2007
January APC Schedule in PDF Format
01/2007
January APC Schedule
in Excel Format
01/2007
Current ATP Tests
and Fees in PDF Format
01/2007
October Fee
Schedule in PDF Format
10/2006
October Fee Schedule
in Excel Format
10/2006
October APC Schedule in PDF Format
10/2006
October APC Schedule
in Excel Format
10/2006
July Fee Schedule
in PDF Format
07/2006
July Fee Schedule
in Excel Format
07/2006
July APC Schedule in PDF Format
07/2006
July APC Schedule
in Excel Format
07/2006
April Fee Schedule
in PDF Format - Updated from June
15!
07/2006
April Fee Schedule
in Excel Format - Updated from June
15!
07/2006
April APC Schedule in PDF Format
06/2006
April APC Schedule
in Excel Format
06/2006
January Fee
Schedule in PDF Format
05/2006
January Fee Schedule
in Excel Format
05/2006
January APC Schedule
in PDF Format
05/2006
January APC Schedule
in Excel Format
05/2006
Previous ATP Tests
and Lab Panel Fees in PDF Format
04/2006
October Fee
Schedule in PDF Format
11/2005
October Fee Schedule
in Excel Format
11/2005
October APC Schedule
in PDF Format
11/2005
October APC Schedule
in Excel Format
11/2005
July Fee Schedule
in PDF Format
08/2005
July Fee Schedule
in Excel Format
08/2005
July APC Schedule
in PDF Format
08/2005
July APC Schedule
in Excel Format
08/2005
April Fee Schedule
in PDF Format
04/2005
April Fee Schedule
in Excel Format
04/2005
April APC Schedule
in PDF Format
04/2005
April APC Schedule
in Excel Format
04/2005
January Fee
Schedule in PDF Format
01/2005 (Updated 02/05)
January Fee
Schedule in ExcelFormat
01/2005 (Updated 02/05)
January APC Schedule
in PDF Format
01/2005
January APC Schedule
in Excel Format
01/2005
October APC Schedule
in PDF Format
10/2004
October APC Schedule
in Excel Format
10/2004
October Fee
Schedule in PDF Format
10/2004
October Fee
Schedule in ExcelFormat
10/2004
July Fee Schedule
in PDF Format
07/2004
July Fee Schedule in Excel Format
07/2004
July APC Schedule
in PDF Format
07/2004
July APC Schedule
in Excel Format
07/2004
April Fee Schedule
in PDF Format
04/2004
April Fee Schedule
in Excel Format
04/2004
April APC Schedule
in PDF Format
04/2004
April APC Schedule in Excel Format
04/2004
Previous ATP Tests
and Fees in PDF Format
03/2004
January Fee
Schedule in PDF Format
01/2004
January Fee
Schedule in Excel Format
01/2004
January APC Schedule in PDF
Format
01/2004
January APC Schedule
in Excel Format
01/2004
Previous APC
Schedule in PDF Format
08/2003
Previous APC
Schedule in Excel Format
08/2003
Previous Fee
Schedule in PDF Format
08/2003
Previous Fee
Schedule in Excel Format
08/2003
Previous Fee Schedule
in PDF Format
07/2002
Previous Fee Schedule
in Excel Format
07/2002
Previous Fee Schedule
in PDF Format
07/2001
Previous Fee Schedule
in Excel Format
07/2001
Notices
and Replacement Pages
08/12/08
Federal
Government May Request Medical Records
07/22/08
Billing
Procedures Regarding Electronic Claims (837P and 837I)
05/29/08
When to Submit
an NDC (National Drug Code) If You Are Billing as a 340B Provider
05/22/08
Frequently
Asked Questions About NPI Reenrollment and Billing -
Updated June 17!
05/13/08
Medicaid/Medicare
Dual Eligible Take-Home and
Self-Administered Drugs
03/17/08
Resubmission
of Denied Claims - Updated March 19!
03/11/08
Billing Procedures
Regarding National Drug Code (NDC) -
Updated April 2!
03/10/08
NPI Reenrollment
and Billing
02/28/08
Enhanced
Claims Editing—Bloodhound ClaimsGuard®
02/20/08
Changes to Prior
Authorization for Circumcision - Updated
August 5!
02/19/08
New HCPCS/CPT
Codes
02/13/08
Tamper-Resistant
Prescription Pads
01/18/08
Possible
Duplicate Claims Processed Through Electronic Data Interchange
01/11/08
Vaccines for Children
(VFC)
12/28/07
New Codes for
Smoking and Tobacco Use Cessation Counseling
12/26/07
WINASAP Upgrade
Required for NDC Data Collection
12/17/07
Enhanced
Claims Editing—Assistant / Team / Co-Surgeon
12/17/07
Enhanced
Claims Editing—Multiple Evaluation and Management Services Provided
on the Same Day
12/03/07
NPI Requirement
for Institutional Healthcare Provider Claims
11/30/07
NDC Requirement
on All Physician-Administered Drugs -
Updated January 17!
11/27/07
Cost Share
Changes
11/01/07
Enhanced
Claims Editing—Add-on Codes
11/01/07
Enhanced
Claims Editing—New Visit Evaluation and Management Codes
11/01/07
Enhanced
Claims Editing—Bloodhound ClaimsGuard®
10/03/07
VFC Update
10/01/07
Attending Provider
10/01/07
Tamper-Resistant
Prescription Pads — Postponed
09/28/07
Smoking and Tobacco
Use Cessation Counseling
09/20/07
Tamper-Resistant
Prescription Pads — Updated
08/01/07
Elimination
of ESOR
07/06/07
Coverage of
17 Alpha-Hydroxyprogesterone Caproate
06/25/07
NPI on
the Web Portal
06/11/07
Ownership
and Control Information Required for Reenrollment
06/06/07
NPI Contingency
Plan Implemented, Reenrollment Extended
05/31/07
New CMS-1500
to Be Required Beginning July 2, 2007
04/16/07
VFC Update-
Updated from January 24!
04/16/07
Coverage of
HPV Vaccine
03/08/07
New and Deleted Codes
03/08/07
Cardiac and Pulmonary
Rehabilitation No Longer Require a Prior Authorization for Outpatient
Settings
01/22/07
ATP Lab Fees
01/18/2007
Admit Hour to
Be Required for Institutional Claims
11/02/06
COBA Update
10/23/06
Mileage Rate
Increase
09/22/06
VFC Update
07/27/06
Billing for Clients
With Medicare and Medicaid—Revised
06/23/06
Notice of
Coverage for New Services - Updated
from June 2!
05/09/06
Changes in Observation
Billing - Updated from January!
04/18/06
VFC Update
04/11/06
ATP Lab Fees
03/01/06
VFC Update
02/10/06
New and Deleted Codes
01/17/06
Critical Access
and Exempt Hospitals Manual Replacement Pages - New Instructions on
Completing Medicaid Hysterectomy Acknowledgement Form
01/16/06
January
2006 Outpatient Prospective Payment System (OPPS) Code Editor (OCE)
Changes
12/28/05
Montana Medicaid
Provider Website Now Offers
Online Medical History
12/16/05
Outpatient Hospital
Manual Replacement pages - New Instructions on Completing Medicaid Hysterectomy
Acknowledgement Form
11/02/05
Critical Access
and Exempt Hospitals Manual Replacement Pages - Unbundling
10/11/05
Critical Access and
Exempt Hospitals Unbundling
07/28/05
Scales - Congestive
Heart Failure
07/01/05
Revised Processing
for Emergency Room Visits
07/01/05
VFC Update
06/23/05
Outpatient Hospital
Manual Replacement Pages - Key Contacts and Hysterectomy Updates (May
2005)
06/01/05
Medicaid Coverage
Update
04/29/05
General Manual
Replacement Page - Member Number a Billable Number and Key Contacts
Updated
04/11/05
Dental Program Coverage
Changes
03/01/05
Hysterectomy Acknowledgement
Update
02/07/05
Obstetric Observation
Billing
02/04/05
Introduction to
Preferred Drug List
02/01/05
New and Deleted Codes
and New Botox Criteria
12/01/04
Billing for Clients
with Medicare and Medicaid
11/05/04
General
Manual Replacement Pages - References to Medicaid Rules/Regulations
Added
10/01/04
Emergency Department
Claims Appeal Process
09/22/04
Hospital
Outpatient Manual Replacement Pages - Team Care Added, Clarification
on Sterilizations, Hysterectomies, Abortions, and MPQHF Phone Number
Change
09/16/04
General Manual
Replacement Pages - Team Care and Nurse First Information Added
07/01/04
Dental and Denturist
Code Changes and Manual Update
06/10/04
Team Care Program
- A New Component of the Passport to Health Program
06/01/04
Important Reminder
Regarding Sterilizations, Hysterectomies and Abortions
04/27/04
Observation
Bed Criteria - Updated
04/27/04
Manual
Replacement Pages - Sterilization/Hysterectomy and PA Update
03/16/04
ATP Lab Fees
02/20/04
Mass Adjustment
02/01/04
New and Deleted
Codes
01/01/04
VFC Changes
- Updated from December!
01/01/04
APCs Updated Quarterly
12/08/03
ED Claim Review
Procedure
12/01/03
Expanded Botox Criteria
12/01/03
VFC Changes
12/01/03
Discontinued Local
Codes
11/10/03
EMTALA Policy Change
10/30/03
Continued Stay Review
for Inpatient Rehabilitation
10/17/03
Q & A Regarding
Reporting ICD-9-CM Procedure Codes
10/14/03
Form Locator Update
09/10/03
Notice dated 06/01/03 - Updated! Discontinued
Services and Services That Now Require Prior Authorization
08/29/03
Passport to Health
Implementation in Prairie County
08/29/03
DMEOPS Advisory Workgroup
Openings
08/20/03
Submitting
HIPAA Compliant Claims - Information for All Providers
08/05/03
ATP Lab Panel
Fees
08/05/03
Lab Panel Crosswalk
08/05/03
Observation
Bed Criteria
07/31/03
Passport and Emergency
Services
07/28/03
Hysterectomy Requirements
05/22/03
Air Transport Changes
05/12/03
Provider Rate and Payment Update
05/01/03
Outpatient Hospital
Lab Panel Update
04/30/03
Gastric Bypass Surgeries
and Circumcisions
04/01/03
Rehabilitation Update
02/03/03
New Billing Requirements
for UB-92 Billers
01/15/03
Dental Program Changes
01/10/03
New Provider
Notification Procedure and Medicaid Changes
10/01/02
Billing for Medicare
Crossovers after Medicare's 45 Day Response Time
09/01/02
Cost Sharing
07/01/02
2.6% Reduction
06/20/02
Passport to Health
24-Hour Availability
02/14/02
Weekly Payment
Available
10/17/01
Dental Implants
08/15/01
HCPCS Coding Clarification
05/29/01
Billing for Lab
Panels
05/09/01
Billing for Abortion
Services
Other
Resources
Outpatient
Prospective Payment System Billing Guide
Power Point presentation: Outpatient Prospective Billing Guide. If you
don't have Microsoft Power Point, you can download
Power Point viewer.
08/28/06
Obstetric Observation
Billing
Directions for billing for obstetric observation
02/01/05
2008 Medicaid
Payment Schedule
Medicaid claims payment schedule for 2008
01/2008
Self
Audit Policy and Procedure
06/2007
Current
ATP Fees
2004-2007 ATP tests and fee schedule
01/2007
Lab
Panels 2007
List of codes that make up lab panels for 2004-2007
01/2007
Carrier ID List
TPL insurance carriers listed by carrier ID
06/2007
Carrier ID
List
TPL insurance carriers listed by name
06/2007
Mental
Health Diagnosis Crosswalk
Covered diagnoses and crosswalk of ICD-9-CM codes to DSM-IV codes
01/2004
EOB
R&R Crosswalk in PDF format
EOB R&R
Crosswalk in Excel format
With the implementation of HIPAA, Medicaid will discontinue the use
of Medicaid EOB codes and begin using HIPAA standard reason and remark
codes (R&R) . This document crosswalks the HIPAA standard R&R
codes to the Medicaid EOB codes.
01/26/04
Outpatient Hospital
Payment Summary
Technical specifications for the new hospital outpatient payment method.
08/2003
Lab
Panel Crosswalk
CPT codes which make up organ or disease oriented panels and evocative/suppression
testing.
08/2003
Remittance
Advice Notice
Your current RA message is as follows:
Mass Adjustment
June 6, 2007
Effective January 1, 2007, payment for services billed with revenue
code 510 was reduced to 80% of the applicable fee or APC for that line.
This change was implemented March 8, 2007. The mass adjustment for 510
revenue codes with dates of service 01/01/2007 through 03/08/2007 will
be run on June 6, 2007, and will show up on your June 11, 2007, remittance
advice.
Key
Contacts
Hospital
08/2002
CHIP
08/2002
Claims
08/2002
County Offices
01/2005
Eligibility
05/2006
Passport
07/2006
Policy Information
07/2006
Prior Authorization
03/2007
