MONTANA MEDICAID
CLIENT INFORMATION
PROVIDER INFORMATION
- Log in to Montana Access to Health
5010 HIPAA Information- Claim Instructions
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- Definitions and Acronyms
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- Site Map
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- Online Enrollment Tutorial
- Online NPI Reenrollment Tutorial
- Online Montana Access to Health Tutorial
Physician
Provider Manuals (Updated May 14, 2012)
Medicaid Rules/Regulations (Updated May 9, 2006)
Fee Schedules (Updated January 30, 2012)
Archived Fee Schedules (Updated February
8, 2010)
Notices and Replacement Pages (Updated May 1, 2012)
Other Resources (Updated May 2, 2012)
Remittance Advice Notice
Key Contacts (Updated April 13, 2012)
Rebateable Manufacturers
(Updated March 28, 2012)
Provider
Manuals
General Information for Providers
Updated April 2012
Medicaid billing manual with general information for all provider types.
04/2012
Physician-Related Services
Updated March 2012
This manual has billing instructions specific to your provider type.
05/2012
Mental Health Services
– Adult
This manual has billing instructions specific to your provider type.
07/2011
Mental Health
Services – Children Updated
September 2011
This manual has billing instructions specific to your provider type.
10/2011
Prescription Drug Program
Updated August 2011
This manual has information specific to your provider type.
09/2011
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 ATP Fee Schedule in Excel
Format
01/2012
Current ATP Fee Schedule in PDF Format
01/2012
Current Fee Schedule in
PDF Format
01/2012
Current Fee Schedule in
Excel Format
01/2012
Previous Fee
Schedule in PDF Format Updated
November 2011
09/2011
Previous Fee
Schedule in Excel Format Updated
November 2011
09/2011
Previous Fee Schedule
in PDF Format
02/2011
Previous Fee Schedule
in Excel Format
02/2011
Previous ATP Fees in PDF
Format
01/2011
Previous
Fee Schedule in PDF Format
07/2010
Previous
Fee Schedule in Excel Format
07/2010
Current Fee Schedule
for Medicaid Mental Health for Clients 18 Years of Age and Older in PDF
Format
07/2010
Current Fee Schedule
for MHSP Services for Clients 18 Years of Age and Older in PDF Format
07/2010
Previous
Fee Schedule for Medicaid Mental Health for Clients 18 Years of Age and
Older in PDF Format
03/2010
Previous Fee Schedule
in PDF Format
02/2010
Previous Fee Schedule
in Excel Format
02/2010
Previous ATP Fees
in PDF Format
02/2010
Previous Fee Schedule
for MHSP Services for Clients 18 Years of Age and Older in PDF Format
Updated March 16
12/2009
Previous Fee Schedule
for 72-Hour Presumptive Eligibility Program for Crisis Stabilization for
Individuals 18 Years of Age and Older in PDF Format
Updated September
1
08/2009
Previous Fee Schedule
in PDF Format Updated July 28
07/2009
Previous Fee Schedule
in Excel Format Updated July 28
07/2009
Previous Fee Schedule
for MHSP Services for Clients 18 Years of Age and Older in PDF Format
07/2009
Previous
Fee Schedule for Medicaid Mental Health for Clients 18 Years of Age and
Older in PDF Format
Updated January 26
07/2009
Previous ATP Fees
in PDF Format Updated March 12
02/2009
Previous Fee Schedule
in PDF Format Updated April 27
01/2009
Previous Fee Schedule
in Excel Format Updated April 27
01/2009
Previous Fee Schedule
for MHSP Services for Clients 18 Years of Age and Older in PDF Format
Updated February 11
02/2009
Previous Fee
Schedule for Medicaid Mental Health for Clients 18 Years of Age and Older
in PDF Format
07/2008
Previous Fee Schedule for
MHSP Services for Clients 18 Years of Age and Older in PDF Format
07/2008
Previous Fee Schedule
in PDF Format
07/2008
Previous Fee Schedule
in Excel Format
07/2008
Previous Fee Schedule
in PDF Format
01/2008
Previous 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
Previous ATP Fees
in PDF Format
01/2007
Notices
and Replacement Pages
(for prescription medication notices, see
the Pharmacy page)
05/03/2012
05/01/12
Passport
and Foster Care
02/15/2012
Non-Coverage of Artificial
Disc
02/13/2012
Emergency Room
Services Update
01/06/12
Smoking
and Tobacco Use Cessation Counselor Services
12/12/11
Qualifier
for Anesthesia Services on HIPAA 5010 837P Transactions
11/07/11
Provider
Information on HIPAA 5010 837 Health Care Claim Transactions
11/04/11
Meeting
the Requirements of HIPAA 5010 When Reporting National Drug Codes on Electronic
837I and 837P Transactions Updated November
16
11/02/11
Smart PA®
Prior Authorization for Synagis®
10/20/11
Prior Authorization
for Children's Vitamins
10/07/11
Influenza Virus
Vaccine
09/09/11
HIPAA 5010/OCR
Qualifier Changes Effective January 1, 2012
09/09/11
DME
Order and Prescription Requirements
09/07/11
Payment Error Rate Measurement (PERM)
06/27/11
HIPAA
5010/OCR Qualifier Changes Effective January 1, 2012
06/24/11
PRTF
Waiver Site Denial Required
06/01/11
17-AHP
and Makena
05/18/2011
Dentist
and Denturist Program Manual Updated
05/05/11
Renew
Passport Provider Agreement
04/12/11
Request:
Claims Submission, Date of Payment by June 30, 2011
03/23/11
Changes
to Procedure Code Indicators
02/07/11
Vaccine
Administration Code Update
11/17/10
17-AHP
11/17/10
Compound
Drugs Billed on a CMS-1500
10/05/10
Changes
to NCCI Edits
09/15/10
Unlinking
Passport Providers No Longer Part of Group Practice
07/28/10
Provider
Record Update Procedures Effective
Immediately
07/15/10
Vaccine
Update Effective February 23, 2010
Fee
Schedule for Mirena
07/07/10
06/23/10
Cost
Sharing Exemption under ARRA
06/23/10
Resource
Based Relative Value Scale (RBRVS) Information
06/22/10
Electronic
Health Records Link
06/04/10
Medicaid
Consultation Services
05/25/10
Medicaid
Incentive Payment Program for Adopting Electronic Health Records
03/29/10
Implantable
Neurostimulators
02/09/10
United
States 2010 Census
02/08/10
Medicaid
Health Improvement Program
02/03/10
Medicaid
Consultation Services
10/08/09
2009
H1N1 Influenza Vaccine and Administration Updated
October 15
10/07/09
Quantity
Limits on Ostomy Products
10/01/09
Healthy
Montana Kids Plan
09/29/09
Update:
SmartPA® Prior Authorization for Synagis®
09/22/09
NDC
Billing Tools
07/16/09
Coverage of Fluoride
Varnish
07/08/09
Anesthesia Providers
04/27/09
Transplant
Program Update Updated
April 30
03/16/09
Timely
Filing for Medicare Crossovers
03/05/09
Vagus
Nerve Stimulation (VNS) Updated
March 10
02/26/09
ATP Lab Fees Updated
March 12
02/25/09
Vaccines
for Children (VFC) Effective as of October 10, 2008
10/20/08
Changes
in Transplant Coverage Updated
October 27
09/03/08
Tamper-Resistant
Rx Pad Update: Three Features Required October 1
09/02/08
Introducing
SmartPA®
08/12/08
Federal
Government May Request Medical Records Updated
September 18
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
04/10/08
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
03/17/08
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
02/20/08
Changes to Prior
Authorization for Circumcision Updated
August 5
02/19/08
New HCPCS/CPT
Codes
02/13/08
Tamper-Resistant
Prescription Pads
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
01/22/08
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
12/03/07
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
08/07/07
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
04/16/07
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
04/18/06
VFC Update
04/11/06
ATP Lab Fees
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
12/02/05
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
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
01/22/04
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
VFC Changes
12/01/03
Discontinued Local
Codes
11/10/03
EMTALA Policy 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
New and Deleted HCPCS/CPT
Codes
03/01/03
Nutrition Services Require Passport
Approval
01/27/03
Optometric Program Update
01/10/03
New Provider
Notification Procedure and Medicaid 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
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
Service
Matrix
Medicaid Mental Health Plan and Mental Health Services Plan (MHSP) for
Youth services excluded from simultaneous reimbursement
01/2011
Previous
ATP Fees
2010 ATP tests and fee schedule
02/2010
Most
Commonly Used NDCs
12/2009
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
Lab
Panels 2007
List of codes that make up lab panels for 2004-2007
01/2007
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 Blepharoplasty
Prior authorization screening criteria for blepharoplasty surgery. See
the Physician Related Services manual for instructions on requesting
prior authorization.
11/2003
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
11/2008
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
