Medicaid Proposed Fee Schedules
The rule hearing for revision of fee schedules for Medicaid provider rates, MAR 37-745 (updates to ARM 37.85.104 and 37.85.105), is scheduled for May 12 at 10: 30 a.m. in the auditorium of the Department of Public Health and Human Services Building, 111 North Sanders, Helena, Montana.
These proposed rules are located on the website. MAR-37-745
The proposed new rates will be effective July 1, 2016. The proposed fee schedule/rates are posted on the website. See Proposed Fee Schedules (link also in left menu). (PD04152016)
Many providers navigate to http://www.medicaidprovider.mt.gov through old site addresses. All old addresses will be retired at the end of April 2016. Providers and billers are urged to make sure that they have bookmarked http://www.medicaidprovider.mt.gov and have deleted any older URLs. (PD03152016)
DPHHS and Xerox will continue to present WebEx sessions on a variety of topics in 2016. See the Training page for details on upcoming WebEx sessions. (PD01222016)
Montana Medicaid Health Improvement Program
The Health Improvement Program for Medicaid and HMK Plus members with chronic illnesses or risks of developing serious health conditions.
HIP is operated through a regional network of 14 community and tribal health centers. Medicaid and HMK Plus members eligible for the Passport program are enrolled and assigned to a health center for possible care management.
Provider referrals to HIP are encouraged.
Instructions and Provider Referral Form
Inappropriate Denials for Physician Administered Drugs for Rebate Agreement Not in Place
During the last payment cycle, Xerox identified claims for Physician Administered Drugs that were denied inappropriately as not being covered because a rebate agreement with the manufacturer was not in place.
Xerox has identified and corrected the issue that caused these denials and will adjust claims that were not paid appropriately.
This adjustment will take place during the next few days, and these claims should be paid and appear on next week’s remittance advices. We apologize for the delay in payment. (PD12182015)
Electronic Funds Transfer (EFT) and Electronic Remittance Advice (ERA) Changes Final Update
This notice supersedes all written documentation regarding EFT and ERAs, including Claim Jumper articles, provider notices, and announcements posted on the Provider Information website.
All Montana Healthcare Programs providers, Medicaid/HMK Plus, CHIP/HMK, and Mental Health Services Plan (MHSP), will be moved to EFT (direct deposit) and ERA over the next two months.
In order to accomplish this transition, Xerox will eliminate both the paper remittance advice option and paper warrants/checks. Some providers were affected as early as December 1, 2014.
To avoid disruption in receiving remittance advices and payments, providers should initiate the change to EFT/ERA as soon as possible. All providers must be registered for the web portal and submit their paperwork to Provider Relations to be eligible for payment and receive applicable ERAs in 2015.
If you are enrolled in EFT, receive ERAs, completed a Trading Partner Agreement (TPA) and have already registered for the Montana Access to Health (MATH) web portal, you meet the requirements of the policy and no additional documentation is needed. Providers who currently receive paper checks and/or paper remittance advices must follow the process below to transition to EFT and ERAs.
To sign up for EFT (direct deposit) and register for the web portal, providers need to complete the documents listed below and mail or fax them to Provider Relations. See the Provider Enrollment page for the needed documents.
Montana Medicaid Electronic Funds Transfer (EFT) & Electronic Remittance Advice (ERA) Authorization Agreement
Trading Partner Agreement
A letter/form on your financial institution's letterhead verifying legitimacy of the account. The letter/form must include the name and contact information of the bank representative, be signed by the bank representative, and verify the account type (checking or savings), financial institution routing number, and provider account number. Do not send voided checks or deposit slips.
To enroll in EFT, a provider must complete and sign the EFT & ERA Authorization Agreement and mail or fax the Agreement and the financial institution letter to provider Relations.
Upon receipt of the form, Provider Relations adds the EFT information to the provider’s profile. This process takes up to 10 business days. Once completed, the provider will get paid via EFT on the next payment cycle.
To receive ERAs, a provider must complete the Trading Partner Agreement (TPA) and register on the MATH web portal to view the ERAs.
1. The provider prints, completes, and signs the TPA. The provider
must include his/her NPI/API on the last page of the TPA.
2. The provider faxes or mails the TPA to Provider Relations.
Once Xerox receives the TPA,the process takes up to 10
3. Xerox mails the Welcome Letter to the provider. This letter
contains the credentials to register for the web portal
(user ID and password) and the provider's submitter ID.
4. Providers can then register online using the information
provided in the Welcome Letter. Click the Log in to
Montana Access to Health link at the top of this page.
You may also want to reference the web portal tutorials:
Web Portal Registration and Web Portal Navigation.
Upon registering, providers are notified via e-mail
that they must change their password and have
24 hours to do so.
5. Once registered, the provider must access Manage Users
and Update or Remove Users and grant yourself Security
Privileges following the instructions given. Providers must
log out and back in for the privileges to take effect.
6. To access a remittance advice (in PDF format), click on
Retrievals and View e!SOR Reports.
Mail or fax enrollment documents to Provider Relations:
P.O. Box 4936
Helena, MT 59604
Providers may also request an 835 ERA delivered to their clearinghouse.
Please contact your clearinghouse or software vendor to begin that process. (PDR11272015)
Important Information Regarding CMS-1500
As of April 1, 2014, the CMS-1500 (08/05) is no longer a valid form for the submission of professional claims. Providers must use the CMS-1500 (02/12) claim form for submission of Medicaid claims for payment.
See the Claim Jumper for information about billing with the 02/12 version and reference the guideline developed by the National Uniform Claim Committee at www.nucc.org. (PD04112014)
Effective January 1, 2014, providers must use the Notice of Retroactive Eligibility (160-M) if a member has been determined retroactively eligible. The FA-455 and FA-454 are no longer accepted.
Providers should attach the Notice of Retroactive Eligibility (160-M) when submitting claims for retroactively eligible member for which the date of service is more than 12 months earlier than the date the claim is submitted. Claims submitted without the Form 160-M will not be paid.
Contact the member’s Office of Public Assistance to request the form. See http://www.dphhs.mt.gov/hcsd/OfficeofPublicAssistance.aspx. (PD042014)
Using Medicaid Card ID for Billing and Checking Eligibility
Providers should use the Medicaid member ID number, not the member’s Social Security number (SSN), for billing purposes and checking eligibility.
This ensures the expenditures are applied to the correct member and any query information is for the correct member. Errors can occur using the SSN for either billing or requesting eligibility information.
If you only have the member’s SSN, have questions, or need assistance, contact Provider Relations at 1.800.624.3958 or via e-mail at MTPRHelpdesk@xerox.com. (PD012014)
Medicare/Medicaid Remittance Advice Reminder and Adjustments
If you do an adjustment, and use a Medicare Remittance Advice Template to print your Medicaid Remittance advice, be aware that not all templates will accommodate the necessary Medicaid information to allow your adjustment to process.
The issue is the length of the ICN that appears on the Medicare Remittance Advice Template. The Medicare ICN is formatted for 15 digits but the Medicaid ICN length is 17 digits. This will truncate the Medicaid ICN by 2 digits.
Check this field and make any necessary corrections. If this is not corrected, we will return your adjustment to you for correction. (PD032013)
NPI Required for Eligibility Verification
Providers must use their NPI/API when inquiring about member eligibility using FaxBack, the Voice Response system or the MATH web portal. If you have questions, call Provider Relations at 1.800.624.3958.
Xerox EDI Solutions Website Links Updated
The Xerox EDI Solutions website has changed. For Montana Medicaid, click on the EDI Solutions Clients tab and choose Montana Department of Public Health and Human Services.
WINASAP 5010 software can be found under the WINASAP tab. EDI enrollment information is available on the EDI Enrollment page. If you are having trouble finding information, contact Provider Relations 1.800.624.3958.
EOB Reason and Remark Crosswalk
An updated version of the EOB Reason and Remark crosswalk, which matches the HIPAA standard R&R codes to the Medicaid EOB codes, is also posted under Other Resources on each provider page in PDF and Excel format.
Eligible Drug Manufacturers
Montana Medicaid reimburses only for drugs that are manufactured by companies that have a signed rebate agreement with CMS. An updated list of these manufacturers is available at the link and on appropriate provider pages. To determine if a manufacturer has signed a rebate agreement, check the first 5 digits of the National Drug Code (NDC) against the list. If there is no match, the drug is not reimbursable.
The list will be updated quarterly, so please check regularly to assure coverage. In addition, the valid NDC must be recorded on the claim (no spaces, no punctuation) as an 11-digit series of numbers. Claims will be denied for drugs billed without a valid 11-digit NDC.
Providers also must be careful when entering the NDC quantity (the administered amount). For more information on billing with NDCs on a CMS-1500, refer to the provider notice dated April 10, 2008. For more information on billing with NDCs on a UB-04, refer to the provider notice dated September 1, 2009.
Medicare Part D Prescription Drug Benefit News
Introduction to Medicare Part D Drug Benefits
Need help with picking the right Part D plan for you or your member?
Stand-Alone Prescription Drug Plans Eligible to Receive Auto-Enrolled Beneficiaries in Montana
The WellPoint Point of Sale system for dual-eligible Medicare and Medicaid eligible individuals:
Learn About the Medicare Prescription Drug Plan
Medicare Prescription Drug Coverage Personal Information Worksheet for People with Medicare and Medicaid
Choosing a Medicare Drug Plan for People with Medicare and Medicaid
People with Medicare and Medicaid: Medicare will enroll you in a plan automatically. How do you find out which plan?
Request for Prescription Information or Change. This is a standard form for exceptions or prior authorizations.
Medicaid Program Information Handbook Insert
Learn more about Medicaid coverage of prescription drugs for members who are dual eligible for both Medicare and Medicaid.
Tamper-Resistant Prescription Pads
List of Tamper-Resistant Prescription Pad Vendors
Get up-to-date Montana Medicaid preferred drug information! Visit the Pharmacy provider page for a list of preferred drugs and upcoming Montana Medicaid and Medicaid Mental Health Drug Use Review Board/Formulary Committee Meetings.
For more information on Montana Prescription Drug Assistance Programs, including help with Medicare Rx premiums, visit Big Sky Rx.