Pharmacy
Provider Manuals (Updated April 29, 2005)
Medicaid Rules/Regulations (Updated May 9, 2006)
Preferred Drug Information (Updated April 21,
2008)
Notices and Replacement Pages (Updated April
30, 2008)
Request for Information: Acquisition Costs (Updated
April 8, 2008)
Other Resources (Updated April 7, 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
Prescription Drug Program
This manual has information specific to your provider type.
11/2004
Medicaid
Rules/Regulations
Administrative
Rules of Montana (ARM)
Montana
Code Annotated (MCA)
Code
of Federal Regulations (CFR)
Preferred
Drug Information
Montana Drug Use Review Board / Formulary Committee
Meetings
Notification of upcoming meetings for drug use review, and minutes from
past meetings
04/21/08
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.
Preferred Drug List Information
List of preferred drugs and other preferred drug list information
04/02/08
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
03/2005
Notices
and Replacement Pages
04/30/08
New Suboxone®
Criteria Sheet
04/09/08
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 April 2!
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
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
Tamper-Resistant Prescription
Pads
CMS guidance and FAQs on tamper-resistant prescription pad laws
09/2007
Tamper-Resistant
Prescription Pad Vendors
04/2008
2008
Medicaid Payment Schedule
Medicaid claims payment schedule for 2008
01/2008
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
NCPDP
3.2 Payer Sheet
Payer sheet for Point of Sale claims
12/2003
NCPDP
5.1 Payer Sheet
Payer sheet for Point of Sale claims
12/2003
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.
Key
Contacts
Pharmacy
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
