Physician
Provider Manuals (Updated July 15, 2008)
Medicaid Rules/Regulations (Updated May 9, 2006)
Fee Schedules (Updated February 11, 2008)
Notices and Replacement Pages (Updated July 22,
2008)
Other Resources (Updated January 2, 2008)
Remittance Advice Notice
Key Contacts (Updated February 21, 2008)
Provider
Manuals
General Information
For Providers
Medicaid billing manual with general information for all provider types.
04/2005
Physician Related
Services
This manual has billing instructions specific to your provider type.
07/2008
Mental Health
This manual has billing instructions specific to mental health services.
10/2003
Prescription Drug
Program
This manual has information on prescriptions and limitations.
11/2004
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
Current Fee Schedule
in PDF Format
01/2008
Current Fee Schedule
in Excel Format
01/2008
Previous Fee Schedule
in PDF Format
10/2007
Previous Fee Schedule
in Excel Format
10/2007
Previous Fee Schedule
in PDF Format
01/2007
Previous Fee Schedule
in Excel Format
01/2007
Current ATP Tests
and Fees in PDF Format
01/2007
Previous Fee Schedule
in PDF Format
07/2006
Previous Fee Schedule
in Excel Format
07/2006
Previous ATP Tests
and Fees in PDF Format
04/2006
Previous Fee Schedule
in PDF Format
01/2006
Previous Fee Schedule
in Excel Format
01/2006
Previous Fee Schedule
in PDF Format
07/2005
Previous Fee Schedule
in Excel Format
07/2005
Previous Fee Schedule in PDF Format
01/2005
Previous Fee Schedule
in Excel Format
01/2005
Previous
Fee Schedule for Medicaid Mental Health and MHSP Services for Clients
18 Years of Age and Older in PDF Format
07/2004
Previous
Fee Schedule for Medicaid Mental Health and MHSP Services for Clients
Under 18 Years of Age in PDF Format
07/2004
Previous Fee Schedule
in PDF Format
07/2004
Previous Fee Schedule
in Excel Format
07/2004
Previous ATP Tests
and Fees in PDF Format
03/2004
Previous
Fee Schedule for Medicaid Mental Health and MHSP Services for Clients
Under 18 years of Age in PDF Format
07/2003
Previous Fee Schedule
in PDF Format
01/2004
Previous Fee Schedule
in Excel Format
01/2004
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 Fee Schedule
in PDF Format
07/2002
Previous Fee Schedule
in Excel Format
07/2002
Previous Fee Schedule
in PDF Format
01/2002
Previous Fee Schedule
in Excel Format
01/2002
Notices
and Replacement Pages
07/22/08
Billing
Procedures Regarding Electronic Claims (837P and 837I)
07/11/08
Changes in
Mental Health Services Plan for Adults Age 18 and Older
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!
05/21/08
Maintenance Medications,
Pharmacy Dispensing Fee Increase, and Signature Log Requirements
05/01/08
RHC/FQHC Taxonomy
on Provider Encounters in Hospitals
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
02/20/08
Changes to Prior
Authorization for Circumcision
02/19/08
New HCPCS/CPT
Codes
02/13/08
Tamper-Resistant
Prescription Pads
02/04/08
Duplicate
Issue - Updated from January 31!
01/29/08
Enhanced Claims
Editing—Medicare Correct Coding Initiative Edits (CCI)
01/28/08
Expansion
of Provider Types for the Mental Health Services Plan
01/28/08
Sedative Hypnotic
Coverage Changes (Ambien CR®, zolpidem, Rozerem®, Lunesta®,
Sonata®
01/28/08
Date of Birth
on Pharmacy Claims—New Feature
01/22/08
Passport
to Health Caseloads to Increase
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
12/21/07
Compound Prescription
Billing Changes - Updated January
16!
12/18/07
Radiopharmaceutical
Pricing 2007 Update
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
12/11/07
Sports Physicals
12/04/07
Carisoprodol
(Soma®) Containing Products to Require Prior
Authorization
12/03/07
NPI Requirement
for Fee-for-Service 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
10/03/07
Rendering 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
08/27/07
Vaccines for
Medicare Part D Participants
08/17/07
Zanaflex®
Capsule
08/07/07
Tamper-Resistant
Prescription Pad Requirement
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
04/19/07
Abilify Dose
Consolidation - Updated from November!
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
02/01/07
Adjustments
to Anesthesia Claims
01/26/07
Mental Health
Claims May Have Been Underpaid
01/22/07
ATP Lab Fees
12/22/06
Prior Authorization
for DMEPOS and Medical/Surgical Procedures Updated Phone and Fax Lines
11/08/06
Prior Authorization
on the Move
10/04/06
Change in Reimbursement
of the -QY Modifier
09/22/06
VFC Update
07/27/06
Billing for Clients
With Medicare and Medicaid—Revised
07/25/06
Physician Related
Services Manual Replacement Pages - Well Child EPSDT Update
06/12/06
Prior Authorization
for Ultram ER
04/18/06
VFC Update
04/11/06
ATP Lab Fees
03/20/06
15-day Supply
Limit Clinical Edit on Initial Atypical Antipsychotic Prescriptions
03/01/06
VFC Update
02/10/06
New and Deleted Codes
01/05/06
Increased Reimbursement
for EPSDT Preventive Services
12/28/05
Montana Medicaid
Provider Website Now Offers
Online Medical History
12/12/05
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
12/08/05
Prior Authorization
Requirements for Rozerem® and Lunesta®
12/02/05
Coverage of Drugs
for Sexual and Erectile Dysfunction Eliminated
10/11/05
Wheelchair
CMNs - Transition Instructions
09/26/05
Blood Draws
(CPT 36415 and 36416)
09/22/05
Telemedicine
07/28/05
Scales - Congestive
Heart Failure
07/01/05
Revised Processing
for Emergency Room Visits
07/01/05
VFC Update
06/01/05
Medicaid Coverage
Update
04/29/05
General Manual
Replacement Page - Member Number a Billable Number and Key Contacts
Updated
04/04/05
Pricing
Logic Changes for Professional (CMS-1500) Claims
03/01/05
Physician
Related Services Manual Replacement Pages - Hysterectomy Acknowledgement
Update
03/01/05
Hysterectomy Acknowledgement
Update
02/04/05
Introduction to
Preferred Drug List
02/01/05
New and Deleted Codes
and New Botox Criteria
Billing for Clients With Medicare and Medicaid
11/16/04
Physician
Manual Replacement Pages - Updated Prescription Drug PA Criteria
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
10/01/04
Emergency Department
Claims Appeal Process
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
Prescription
Drug Manual Replacement Pages - PA and HIPAA Updates
06/10/04
Prescription Drug
Prior Authorization Additions
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
03/16/04
ATP Lab Fees
02/01/04
New and Deleted
Codes
01/29/04
Prior Authorization
Additions
01/22/04
Lab and Radiology
Services Covered Under MHSP Plan
01/01/04
VFC Changes
- Updated from December!
01/01/04
New
and Discontinued Optometric Codes
12/23/03
Manual Replacement
Pages for Immunizations, PA Criteria, Family Planning, and Using Modifiers
12/08/03
ED Claim Review
Procedure
12/01/03
Bilateral X-ray
Reimbursement Update
12/01/03
High Risk Pregnant
Women (HRPW) Changes
12/01/03
Expanded Botox Criteria
12/01/03
VFC Changes
12/01/03
Discontinued Local
Codes
11/25/03
Prior Authorization
Changes, Coverage of Loratadine, and Compound Prescriptions
11/10/03
EMTALA Policy Change
10/16/03
Prior Authorization
Change
09/16/03
Physician Manual Replacement
Pages for Hysterectomies and Prescription Drug PA Update
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
and Physician Manual Replacement Pages
06/01/03
Discontinued Services
That Now Require Prior Authorization
06/01/03
Replacement
Pages for Physician Manual - New PA Requirements and Hysterectomy Information
05/28/03
Change in Reimbursement
for Interactive Psychotherapy
05/12/03
Provider Rate and Payment Update
05/01/03
Outpatient Hospital
Lab Panel Update
04/30/03
Gastric Bypass Surgeries
and Circumcisions
03/01/03
Pharmacy Prior Authorization and Refill
Changes
03/01/03
New and Deleted HCPCS/CPT
Codes
03/01/03
Nutrition Services Require Passport
Approval
01/29/03
Prescription Drug
Update
01/27/03
Optometric Program
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
12/01/02
Program Changes and
Updates
10/07/02
Presumptive Eligibility
10/01/02
Billing for Medicare
Crossovers After Medicare's 45 Day Response Time
09/26/02
DME Update
09/01/02
Cost Sharing Replacement
Page - Physician Related Services
09/01/02
Cost Sharing
07/01/02
2.6% Reduction
07/01/02
Passport Provider
Approval Update
06/20/02
Passport to Health
24-Hour Availability
03/21/02
Prior Authorization
Reminders: DME, DMEOPS
02/14/02
Weekly Payment
Available
10/17/01
Dental Implants
01/26/01
New Definitions for
SED and SDMI
Other
Resources
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
Criteria
for Blepharoplasty
Prior authorization screening criteria for blepharoplasty surgery. See
the Physician Related Services manual for instructions on requesting
prior authorization.
11/2003
Criteria for
Botox
Prior authorization screening criteria for botox injections. See the
Physician Related Services manual for instructions on requesting
prior authorization.
01/2005
Criteria
for Circumcision
Screening criteria for circumcision. See the Physician Related Services
manual for instructions on requesting prior authorization.
11/2003
Criteria for Excising Excess Skin and Subcutaneous Tissue
Prior authorization screening criteria for excising excessive skin and
subcutaneous tissue including lipectomy and abdominoplasty. See the
Physician Related Services manual for instructions on requesting
prior authorization.
11/2003
Criteria
for Contact Lenses
Prior authorization screening criteria for contact lenses. See the
Physician Related Services manual for instructions on requesting
prior authorization.
11/2003
Criteria
for Dermabrasion, Abrasion, and Chemical Peel
Prior authorization screening criteria for dermabrasion, abrasion, and
chemical peel. See the Physician Related Services manual for
instructions on requesting prior authorization.
11/2003
Criteria for
Prophylactic Mastectomy
Prior authorization screening criteria for prophylactic Mastectomy.
See the Physician Related Services manual for instructions
on requesting prior authorization.
11/2003
Notice for Surgery Following
Mastectomy
This notifies providers that all health plans that cover mastectomies
must also cover reconstructive surgery.
11/2003
Criteria for Rhinoplasty
and Septorhinoplasty
Prior authorization screening criteria for rhinoplasty and septorhinoplasty.
See the Physician Related Services manual for instructions
on requesting prior authorization.
11/2003
Criteria for Temporomandibular
Joint (TMJ) Arthroscopy/Surgery
Prior authorization screening criteria for temporomandibular joint arthroscopy/surgery.
See the Physician Related Services manual for instructions
on requesting prior authorization.
11/2003
Criteria
for Maxillofacial/Cranial Surgery
Prior authorization screening criteria for maxillofacial/cranial surgery.
See the Physician Related Services manual for instructions
on requesting prior authorization.
11/2003
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
Physicians
02/2008
CHIP
08/2002
Claims
08/2002
County Offices
01/2005
Eligibility
05/2006
Passport
07/2006
Policy Information
07/2006
Prior Authorization
03/2007
