MONTANA MEDICAID
CLIENT INFORMATION
PROVIDER INFORMATION
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5010 HIPAA Information- Claim Instructions
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Pharmacy
Provider Manuals (Updated April 13, 2012)
Medicaid Rules/Regulations (Updated May 9, 2006)
Preferred Drug Information (Updated May 9, 2012)
Notices and Replacement Pages (Updated May 3, 2012)
Request for Information: Acquisition Costs (Updated
April 8, 2008)
Other Resources (Updated May 3, 2012)
SMAC Information (Updated May 14, 2012)
MHSP
Preferred Manufacturers (Updated December 9, 2011)
MHSP Formulary (Updated
September 1, 2011)
Rebateable Manufacturers
(Updated March 28, 2012)
Key Contacts (Updated April 13, 2012)
Provider
Manuals
General Information for Providers
Updated April 2012
Medicaid billing manual with general information for all provider types.
04/2012
Prescription Drug Program Updated
December 2011
This manual has information specific to your provider type.
02/2012
Medicaid
Rules/Regulations
Administrative
Rules of Montana (ARM)
Montana
Code Annotated (MCA)
Code
of Federal Regulations (CFR)
Preferred
Drug List
List of preferred drugs and other preferred drug list information
05/09/2012
Montana Drug Use Review Board / Formulary Committee
Meetings
Notification of upcoming meetings for drug use review, and minutes from
past meetings
05/08/2012
Evidence-Based
Medicine Documentation
Resources used by the Montana Formulary Committee members come from the
OHSU Drug Effectiveness Review Project which can be accessed through this
link.
Mental Health Preferred Drug List Workgroup
Information
Link to agendas and minutes of workgroup meetings
02/2005
Drug
Use Review Board
Information on the Medicaid Drug Use Review Board
07/2011
05/03/12
Dispense as
Written (DAW) = 9
NCPDP D.0 Payer
Sheet Updated May 3, 2012
03/08/2012
Vaccines for Children (VFC)
Training
02/29/2012
NCPDP D.0
Submission Requirements Important
Update
02/29/2012
Vaccine
Administration by Pharmacists for Adolescents Age 12–18 Important
Update
02/29/2012
Coordination
of Benefits Under NCPDP D.0
02/13/2012
New
Medications under Prior Authorization and the Authorization Criteria Effective
February 6, 2012
02/01/12
Replacement Pages, Prescription
Drug Services
Multiple Pages
12/30/11
NCPDP D.0 Submission
Requirements Important Update
12/09/11
Medicare
Part B Crossover Claims Important
Update
12/08/11
NCPCP D.0
Implementation Important Update
11/07/11
Provider
Information on HIPAA 5010 837 Health Care Claim Transactions
11/02/11
Smart PA®
Prior Authorization for Synagis®
10/20/11
Prior Authorization
for Children's Vitamins
09/15/11
NCPDP
D.0 Submission Requirements Important
Update
09/09/11
HIPAA 5010/OCR
Qualifier Changes Effective January 1, 2012
09/07/11
Payment Error Rate Measurement (PERM)
09/01/11
Replacement Pages Prescription
Drug Services
Medicaid Covered Services and Reimbursement (Dispensing Fee) and MHSP
Covered Products (Formulary Drugs)
07/29/11
NCPDP D.0
Submission Requirements
07/22/11
Reduction
of In-State Pharmacy Provider Dispensing Fees
06/27/11
HIPAA
5010/OCR Qualifier Changes Effective January 1, 2012
06/17/11
Replacement
Pages Prescription Drug Services (entire manual)
05/27/11
Prior
Authorization for Horizant®,
Gralise®,
Daliresp®
and Sprix®
04/12/11
Request:
Claims Submission, Date of Payment by June 30, 2011
04/12/11
Prior
Authorization for Cycloset®
04/12/11
Prior
Authorization for Pradaxa®
04/12/11
Prior
Authorization for Nexiclon®
02/23/11
Prior
Authorization for Abstral®
01/05/11
Prior
Authorization for Kapvay®
10/05/10
Changes
to NCCI Edits
07/28/10
Provider
Record Update Procedures Effective
Immediately
06/23/10
Cost
Sharing Exemption under ARRA
06/22/10
Electronic
Health Records Link
02/25/10
State
Maximum Allowable Cost (SMAC)
02/09/10
United
States 2010 Census
02/08/10
Medicaid
Health Improvement Program
12/15/09
Prior
Authorization for Intuniv®
12/04/09
Prior
Authorization for Elidel® and Protopic®
12/04/09
Prior
Authorization for Embeda®
Updated
February 3
12/04/09
Prior
Authorization for Nucynta®
11/24/09
Provider
Name and Phone Number Required Fields
10/01/09
Healthy
Montana Kids Plan
09/29/09
Update:
SmartPA® Prior Authorization for Synagis®
09/22/09
NDC
Billing Tools
06/29/09
Dispensing Fee
Increase
05/19/09
Latisse® (bimatoprost)
Not Covered by Montana Medicaid
05/19/09
Prior Authorization
Requirements for Relistor®
05/19/09
Prior Authorization
Requirements for Provigil and Nuvigil®
05/07/09
Prior Authorization
for Savella®
04/16/09
Coordination
of Benefits: Updated
Updated April 17
04/14/09
Prior
Authorization Addition: Lidoderm®,Voltaren Gel®, Flector Patches®
Updated
April 21
04/14/09
Prior
Authorization Addition: Uloric® Updated
April 21
04/14/09
Prior
Authorization for Ryzolt® Updated
April 21
04/10/09
PRTF
Three-Day Medication Supply
03/16/09
Timely
Filing for Medicare Crossovers
01/12/09
Change
in Policy Regarding NCPDP Fields Dispense As Written (DAW) Product Selection
Codes 5 and 7
01/12/09
Refill
Too Soon Edit Set to 90 Percent for Gabapentin
10/20/08
Changes
in Transplant Coverage Updated
October 27
09/04/08
SmartPA®
Prior Authorization for Synagis®
09/04/08
SmartPA®
Prior Authorization for Marinol®
09/03/08
SmartPA®
Prior Authorization for Seroquel®
09/03/08
Tamper-Resistant
Rx Pad Update: Three Features Required October 1
09/03/08
SmartPA®
Maximum Daily Amounts for Acetominophen
09/02/08
Introducing
SmartPA®
08/26/08
Benefiber®
Not Covered
08/12/08
Federal
Government May Request Medical Records Updated
September 18
07/14/08
Delayed Payment
for Pharmacy Providers
06/16/08
Pharmacy Claims
Pricing Adjustment
05/22/08
Frequently
Asked Questions About NPI Reenrollment and Billing -
Updated June 17!
05/21/08
Maintenance Medications,
Pharmacy Dispensing Fee Increase, and Signature Log Requirements
04/30/08
New Suboxone®
Criteria Sheet
04/10/08
Billing Procedures
Regarding National Drug Code (NDC) for Providers Using the CMS-1500 and
837-P
04/01/08
Preferred Drug
List (PDL): Brand Products No Longer Preferred
Over Generics
03/20/08
Effexor XR®
Dose Consolidation Updated April 22
03/17/08
Resubmission
of Denied Claims Updated March 19
03/11/08
Billing Procedures
Regarding National Drug Code (NDC) Updated
October 15
03/10/08
NPI Reenrollment
and Billing
02/29/08
Prescription
Origin Code Enabled
02/13/08
Tamper-Resistant
Prescription Pads
02/07/08
NPI-Only Requirement
for Pharmacies
01/28/08
Sedative Hypnotic
Coverage Changes (Ambien CR®, zolpidem, Rozerem®, Lunesta®,
Sonata®
01/28/08
Date of Birth
on Pharmacy Claims—New Feature
01/18/08
Possible
Duplicate Claims Processed Through Electronic Data Interchange
12/21/07
Compound Prescription
Billing Changes Updated January 16
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
12/04/07
NPI Requirement
for Fee-for-Service Healthcare Provider Claims
12/04/07
Carisoprodol
(Soma®) Containing Products to Require Prior
Authorization
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®
10/31/07
Pharmacy 835
RA Problems
10/01/07
Tamper-Resistant
Prescription Pads — Postponed
09/20/07
Tamper-Resistant
Prescription Pads — Updated
08/17/07
Zanaflex®
Capsule
08/07/07
Tamper-Resistant
Prescription Pad Requirement
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
05/22/07
NPI Contingency
Planning
04/19/07
Abilify Dose Consolidation Updated from November
01/09/07
Prior Authorization
Addition
08/30/06
Extended Hours
for Team Care Pharmacy Lock-in Suspensions
07/21/06
Medicare Part B Crossover Changes
Updated August 2011
06/12/06
Prior Authorization
for Ultram ER
05/05/06
Refill Too Soon
Edit Set to 90% for Controlled Substances (CII-CV) and Tramadol Products
03/20/06
15-day Supply
Limit Clinical Edit on Initial Atypical Antipsychotic Prescriptions
03/13/06
Prior Authorization
for Suboxone®/Subutex®
02/08/2006
Prior Authorization
Requirements for Rozerem® and Lunesta®
Updated from December
01/13/06
Erroneous Deductibles
and High Co-Pays With Medicare Part D
12/02/05
Coverage of Drugs
for Sexual and Erectile Dysfunction Eliminated
Pharmacy Audit Codes
07/28/05
Scales - Congestive
Heart Failure
05/11/05
Pharmacy Reviews
04/29/05
General Manual
Replacement Page - Member Number a Billable Number and Key Contacts
Updated
04/07/05
Heparin Flush Syringes
- Coverage Issues
04/04/05
Member Number
Now a Billable Number
02/04/05
Introduction to
Preferred Drug List
02/02/05
Prior Authorization
Addition
12/23/04
NDC Deletions Effective
January 1, 2005
11/16/04
Pharmacy
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
06/16/04
Prescription
Drug Manual Replacement Pages - PA and HIPAA Updates
06/10/04
Team Care Program
- A New Component of the Passport to Health Program
06/10/04
Prior Authorization
Additions
01/29/04
Prior Authorization
Additions Updated 02/04
01/08/04
Payment From Other
Insurance Companies
12/31/03
Important Update
for NCPDP 5.1 Submitters
12/31/03
Important Update
for NCPDP 3.2 Submitters
12/01/03
Billing Other Health
Insurance Before Medicaid
11/25/03
Prior Authorization
Changes, Coverage of Loratadine, and Compound Prescriptions
10/16/03
Prior Authorization
Change
09/30/03
NCPDP 5.1 Delayed
Until October 16, 2003
09/05/03
Verifying Eligibility
With the Montana Access to Health Medicaid Hard Card
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
08/20/03
Submitting HIPAA
Compliant Claims - Information for Pharmacies
08/20/03
New Pharmacy
Manual and Program Changes
07/25/03
MHSP Pharmacy
Changes
03/01/03
Pharmacy Prior Authorization and Refill
Changes
01/29/03
Prescription Drug
Update
01/10/03
New Provider
Notification Procedure and Medicaid Changes
01/02/03
Drug Prior Authorization
Changes
01/02/03
Prior Authorization
Replacement Pages
10/01/02
Billing for Medicare
Crossovers After Medicare's 45 Day Response Time
09/01/02
Cost Sharing Replacement
Page
09/01/02
Cost Sharing
08/01/02
Cost Sharing Notice
(Pharmacy)
07/01/02
2.6% Reduction
06/20/02
Passport to Health
24-Hour Availability
03/21/02
Prior Authorization
Reminders: DME, DMEOPS
02/14/02
Weekly Payment
Available
Request
for Information: Acquisition Costs
Department
Request
04/08/08
Drug Cost Spreadsheet
04/08/08
Other
Resources
NCPDP D.0 Payer
Sheet
05/2012
Drugs Requiring
Prior Authorization
12/30/2011
NCPDP 5.1 Payer
Sheet
Payer sheet for point-of-sale claims
04/2011
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 (R&R)
codes. This document crosswalks the HIPAA standard R&R codes to the
Medicaid EOB codes.
02/2011
Most
Commonly Used NDCs
12/2009
Cost
to Dispense Survey
06/2009
List
of Bulk Powders for Compound Medications—Rebateable as of 08/27/2008
08/2008
Tamper-Resistant
Prescription Pads
CMS guidance and FAQs on tamper-resistant prescription pad laws
09/2007
Tamper-Resistant
Prescription Pad Vendors
11/2011
Self Audit
Policy and Procedure
04/2009
Carrier
ID List
TPL insurance carriers listed by carrier ID
05/2012
Carrier
ID List
TPL insurance carriers listed by name
05/2012
SMAC
Information
Montana SMAC
List
05/14/2012
SMAC
Pricing Inquiry Worksheet
02/2010
Key
Contacts
Pharmacy
10/2011
Claims
03/2012
Public Assistance Offices
03/2012
Client Eligibility
04/2012
HMK/CHIP
12/2010
Passport
03/2012
Policy Information
03/2012
Prior Authorization
03/2012
