EPSDT

Provider Manuals (Updated November 2, 2006)
Medicaid Rules/Regulations (Updated May 9, 2006)
Fee Schedules (Updated March 5, 2007)
Notices and Replacement Pages (Updated October 27, 2008)
Other Resources (Updated December 31, 2008)
Remittance Advice Notice
Key Contacts (Updated November 18, 2008)

Provider Manuals
General Information For Providers
Medicaid billing manual with general information for all provider types.
04/2005

EPSDT
This manual has billing instructions specific to your provider type.
11/2006

Physician Related Services
This manual has billing instructions specific to your provider type.
07/2006

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Medicaid Rules/Regulations
Administrative Rules of Montana (ARM)
Montana Code Annotated (MCA)
Code of Federal Regulations (CFR)

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Fee Schedules
Current Respiratory Therapy Fee Schedule in PDF Format
01/2007

Current Respiratory Therapy Fee Schedule in Excel Format
01/2007

Current Chiropractic Fee Schedule in PDF Format
01/2007

Current Chiropractic Fee Schedule in Excel Format

01/2007

Previous Respiratory Therapy Fee Schedule in PDF Format
07/2006

Previous Respiratory Therapy Fee Schedule in Excel Format
07/2006

Current Fee Schedule in PDF Format
01/2006

Current Fee Schedule in Excel Format
01/2006

Previous Fee Schedule in PDF Format
07/2003

Previous Fee Schedule in Excel Format
07/2003

Previous Fee Schedule in PDF Format
01/2003

Previous Fee Schedule in Excel Format
01/2003

Previous Chiropractic Fee Schedule in PDF Format

07/2001

Previous Chiropractic Fee Schedule in Excel Format
07/2001

Previous Respiratory Fee Schedule in PDF Format
07/2001

Previous Respiratory Fee Schedule in Excel Format
07/2001

Previous Fee Schedule in PDF Format

01/2001

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Notices and Replacement Pages
10/20/08
Changes in Transplant Coverage - Updated October 27!

08/12/08
Federal Government May Request Medical Records
- Updated September 18!

07/10/08
Multiple Conversion Factors for RBRVS Providers

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!

03/17/08
Resubmission of Denied Claims - Updated March 19!

03/10/08
NPI Reenrollment and Billing

01/18/08
Possible Duplicate Claims Processed Through Electronic Data Interchange

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 Fee-for-Service Healthcare Provider Claims

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®

08/01/07
Elimination of ESOR

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

07/25/06
EPSDT Manual Replacement Pages - Well Child EPSDT Update

07/25/06
Physician Related Services Manual Replacement Pages - Well Child EPSDT Update

07/14/06
EPSDT Private Duty Nursing Service Changes

04/25/06
Physician Related Services Manual Replacement Pages - Revised Instructions for Completing a Claim, Revised Information on How Cost-Sharing Affects Claim Payment

01/05/06
Increased Reimbursement for EPSDT Preventive Services

01/05/06
Physician Related Services Manual Replacement Pages - New EPSDT Chapter, Hysterectomy Acknowledgement Form, and Revised Information on Imaging Modifiers, Billing for Immunizations, and ER Visits for Clients Under Age 2

07/28/05
Scales - Congestive Heart Failure

04/29/05
General Manual Replacement Page - Member Number a Billable Number and Key Contacts Updated

03/01/05
Physician Related Services Manual Replacement Pages - Hysterectomy Acknowledgement Update

02/04/05
Introduction to Preferred Drug List

01/25/05
Physician Related Services Manual Replacement Pages - Rule References Added, Updates to Covered Services, PA and Modifiers

11/16/04
Physician Manual Replacement Pages - Updated Prescription Drug PA Criteria

11/05/04
General Manual Replacement Pages - References to Medicaid Rules/Regulations Added

09/16/04
General Manual Replacement Pages - Team Care and Nurse First Information Added

09/15/04
Physician Manual Replacement Pages - Team Care Added

06/16/04
Physician Manual Replacement Pages - Clarification on Sterilizations, Hysterectomies, Abortions and HIPAA and Drug PA Update

06/10/04
Team Care Program - A New Component of the Passport to Health Program

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

05/12/03
Provider Rate and Payment Update

01/10/03
New Provider Notification Procedure and Medicaid Changes

10/01/02
Billing for Medicare Crossovers after Medicare's 45 Day Response Time

07/01/02
2.6% Reduction

06/20/02
Passport to Health 24-Hour Availability

02/14/02
Weekly Payment Available

06/01/01
Global Surgery Period Billing

03/20/00
Global Surgery Period Billing

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Other Resources
2009 Medicaid Payment Schedule
Medicaid claims payment schedule for 2009
12/2008

Self Audit Policy and Procedure
06/2007

Carrier ID List
TPL insurance carriers listed by carrier ID
06/2007
Carrier ID List
TPL insurance carriers listed by name
06/2007

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

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Remittance Advice Notice
Your current RA message is as follows:

New 1099 Process
December 14, 2006

Medicaid providers will see a change in the 1099s received for 2006 reporting Medicaid payments. Effective for calendar year 2006 and forward, ACS will no longer be generating and mailing a separate 1099 for Medicaid payments. The Department of Administration will be combining all payments by tax identification number into one 1099 instead of a separate 1099 for each Medicaid provider number. If you have any questions, please contact Roy Hinman at (406) 444-5932 or Susan Austad (406) 444-4060 at the Department of Public Health and Human Services.

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Key Contacts
EPSDT
11/2008

CHIP
08/2002

Claims
08/2002

County Offices
01/2005

Eligibility
05/2006

Passport
07/2006

Policy Information
07/2006

Prior Authorization
03/2007

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(Updated September 18, 2008)