Hospital Inpatient Hospital Inpatient Provider Manuals General Information for Providers 02/2017 Medicaid manual with general information for all provider types. Hospital Inpatient Services 01.2016 This manual has information specific to your provider type. Critical Access Hospitals 01.2016 This manual has information specific to critical access hospitals. Provider Manuals - Replacement Pages General Information for Providers 02/06/2017 In summary, the Telemedicine Chapter was added as a new chapter. And the Medically Needy section of the Member Responsibilities Chapter page 6.5 was updated. 08.02.2016 The Introduction contains updated links in the HELP section. Cost Share was updated in the Billings Procedure. A duplicate word was removed in the RA chapter. The Cover Page was changed to reflect the current date of the new General Manual revision. 07.12.2016 General Information For Providers, July 2016 Table of Contents was amended by changing the title of “Basic Medicaid Waiver” to “Waiver for Additional Services and Populations (formerly Basic Medicaid Waiver)”. Index was amended by changing the title of “Basic Medicaid Waiver” to “Waiver for Additional Services and Populations (formerly Basic Medicaid Waiver)”. Page 1.3 changed the title “Basic Medicaid Waiver for Additional Services and Populations” to “Waiver for Additional Services and Populations (formerly Basic Medicaid Waiver)” 01.19.2016 General Information for Providers, January 2016: Introduction Regarding HELP Plan Information 01.15.2016 General Information for Providers, January 2016: Introduction Regarding HELP Plan Information 12.31.2015 General Information for Providers, January 2016: HELP Plan-Related Updates and Others 11.17.2015 General Information for Providers, November 2015: Billing Procedures, Revenue Codes 25X and 27X 07.31.2015 General Information for Providers, August 2015: Entire Manual 11.19.2014 General Information for Providers, November 2014: Billing Procedures 10.08.2014 General Information for Providers, September 2014: Billing Procedures 07.22.2014 General Information for Providers, July 2014: Member Eligibility and Responsibilities 06.30.2014 General Information for Providers, June 2014: General Information for Providers If information is found on the website, it has been removed from the manual, and a link to the source is provided. 04.13.2012 General Information for Providers, April 2012: Medicaid Covered Services and Client Eligibility Critical Access and Exempt Hospitals 12.31.2015 Critical Access and Exempt Hospitals, January 2016, HELP Plan-Related Updates and Others 04.27.2015 Critical Access and Exempt Hospitals, April 2015: Multiple Chapters 04.01.2014 Critical Access and Exempt Hospitals, March 2014: Key Contacts, MPQH Telephone and Fax 01.17.2006 Critical Access and Exempt Hospitals, January 2006: New Instructions on Completing Medicaid Hysterectomy Acknowledgement Form 11.02.2005 Critical Access and Exempt Hospitals, November 2005: Bundled Services Medicaid Rules and Regulations Code of Federal Regulations (Title 42) Montana Code Annotated (Title 53, Chapter 6) Administrative Rules of Montana (Title 37) Chapter 79 Healthy Montana Kids Chapter 82 Medicaid Eligibility Chapter 83 Medicaid for Certain Medicare Beneficiaries and Others Chapter 85 General Medicaid Services Chapter 86 Medicaid Primary Care Services Fee Schedules - Hospital - APR DRG APR - DRG FAQ PDF Excel October 2016 APR-DRG Calculator October 2016 APR-DRG Calculator July 2015 APR-DRG Rev. 04.22.2016 July 2015 APR-DRG Rev. 04.22.2016 July 2014 July 2014 July 2013 July 2013 April 2012 April 2012 Provider Notices 2010– 2017 02/23/2017 Mass Adjustment to Correct the Base Rate Calculation 02/02/2017 EPSDT ( Children's) Lead Screening Requirements 2016 11/01/2016 Smart PA® for Synagis® Revised 11/15/2016 10/28/2016 ICD 10 Updates and Coding Changes Revised 12/07/2016 10/18/2016 Inpatient PPS Hospital Stays with Split Medicaid eligibility and the HELP TPA Plan through BCBS - Revised 10/21/2016 09/27/2016 Physician Administered Drugs - NDC Requirements Revised 07.28.2016 Montana Plan First Preventive Code Additions 07.25.2016 Admission Date and Statement Covers Period - Revised 07.18.2016 Changes to Member Cost Share Update 07.12.2016 Vaccine Administration Code Update 07.05.2016 PA For Botox No Longer Required 07.05.2016 Circumcision Prior Authorization Changes 07.01.2016 Admission Date and Statement Covers Period 05.19.2016 Changes to Member Cost Share 02.01.2016 Basic Medicaid Benefit Increased to Standard Medicaid Benefit 01.28.2016 LARC Inserted at Time of Delivery in PPS Hospital 01.15.2016 Standard Medicaid and HELP Plan Claims Processing Rev. 01.19.2016 01.15.2016 Hospital Grade Electric Breast Pump Requirements 2015 12.31.2015 Changes to Montana Medicaid 12.30.2015 Addictive and Mental Disorders Division Changes to Prior Authorization 11.23.2015 Prior Authorization Requests and Medical-Surgical Prior Authorization Request Form Rev. 12.2015 11.18.2015 Hospital National Drug Code (NDC) Billing on Revenue Codes Rev. 12.21.2015 11.03.2015 Services Exempt from Passport to Health Referral 10.21.2015 ICD-10 Obstetric Observation Billing 10.21.2015 SmartPA® Prior Authorization for Synagis® 10.09.2015 Montana Plan First – ICD-10 Update 10.01.2015 Changes to the Children's Mental Health Bureau Medicaid Services Provider Manual 08.19.2015 Identification of Ordering and Referring Providers on UB-04 and 837I X12 Transactions 08.17.2015 Medicare Crossover Claims With Medicare Non-Covered Charges That Medicaid Allows 08.03.2015 ICD-10 Guidance for Implementing International Classification of Diseases, 10th Edition (ICD-10) 07.31.2015 Adult and Pediatric Specialty Table of Services Available in Montana 07.08.2015 Montana Plan First – Revised List of Plan First Covered Services 03.11.2015 Criteria for Breast Reconstruction 03.11.2015 Criteria for Prophylactic Mastectomy 02.11.2015 New HCPCS Modifiers – XE, XP, XS, and XU 01.30.2015 Telehealth Diagnosis Codes 01.07.2016 Long Acting Reversible Contraception (LARC) Inserted at Time of Delivery in a PPS Hospital 2014 12.18.2014 Electronic Funds Transfer (EFT) and Electronic Remittance Advice (ERA) Changes Final Notice 10.20.2014 SmartPA® Prior Authorization for Synagis® 09.16.2014 Adoption of the New Children's Mental Health Bureau's Medicaid Provider Manual into Administrative Rules of Montana 09.01.2014 Cardiac and Pulmonary Rehabilitation Outpatient Updates 08.05.2014 Montana Prescription Drug Registry 06.25.2014 Elective Deliveries – Hospitals 06.12.2014 ICD-10 Delay 05.13.2014 PERM Provider Educational Webinars 04.02.2014 Medicaid and G Codes Update 03.18.2014 Information Regarding CMS-1500 01.29.2014 Centers for Medicare and Medicaid Services (CMS) ICD-10 Provider Readiness Assessment Update 01.09.2014 Using Medicaid Card ID Number When Billing and Checking Eligibility 01.09.2014 Reimbursement Changes for Covered Ancillary Services Provided to Youth in a PRTF and Additional Information Pertaining to PRTF Services 2013 12.23.2013 Electronic Funds Transfer (EFT) and Electronic Remittance Advice (ERA) Changes Update 11.26.2013 ICD-10 Readiness 09.27.2013 Changes to Prior Authorization Requirements for Therapeutic Youth Group Homes – Additional Information 09.24.2013 Changes to Contract With Magellan Medicaid Administration (MMA) 09.11.2013 Electronic Funds Transfer (EFT) and Electronic Remittance Advice (ERA) Changes 09.03.2013 Changes to Contract With Magellan Medicaid Administration (MMA) 07.08.2013 Montana Medicaid DSM-5 Implementation 06.28.2013 PRTF Montana-CANS Implementation 06.20.2013 Montana Plan First – Additional Information 05.31.2013 Children's Mental Health Services Plan (CMHSP) Rules Repealed 05.28.2013 DPHHS to Discontinue Temporary Hotline Number 05.13.2013 Montana Plan First – Revised List of Plan First Covered Services 03.11.2013 Molecular Pathology Procedure Codes 02.19.2013 Montana Medicaid HIPAA Operating Rules Upgrade 02.12.2013 BRCA1 and BRCA2 Testing Update 05.06.2013 Passport to Health Disenrollment Requirements for Providers Disenrolling a Member 02.11.2013 Montana Plan First Additional Information Updated 01.28.2013 Participating Providers: Prevention of Diabetes and Cardiovascular Disease 2012 12.26.2012 Medicaid/HMK Plus Toll-Free Number 12.24.2012 BRCA1 and BRCA2 Testing 12.17.2012 American Medical Association Adopts New Psychiatric Diagnostic and Psychological Codes 09.26.2012 Changes to the Children's Mental Health Bureau's Provider Manual and Clinical Guidelines for Utilization Management and Authorization Request Forms 08.22.2012 Deleted ICD-9-CM Codes 06.11.2012 Plan First Effective 06.01.2012 02.15.2012 Non-Coverage of Artificial Disc 02.13.2012 Emergency Room Services Update 01.06.2012 Smoking and Tobacco Use Cessation Counselor Services 01.06.2012 Psychiatric Residential Treatment Facility (PRTF) Prior Authorization Start Date Must Match Admission Date 2011 11.07.2011 Provider Information on HIPAA 5010 837 Health Care Claim Transactions 11.04.2011 Meeting the Requirements of HIPAA 5010 When Reporting National Drug Codes on Electronic 837I and 837P Transactions 11.16.2011 09.09.2011 HIPAA 5010 OCR Qualifier Changes Effective January 1, 2012 09.07.2011 Payment Error Rate Measurement (PERM) 07.18.2011 Reimbursement Changes for Covered Ancillary Services Provided to Youth in a PRTF and Additional Ancillary Services Are Covered 07.18.2011 Prior Authorization Requirements Discontinued for Targeted Case Management (TCM) and Outpatient Therapy Concurrent With Comprehensive School Community Treatment (CSCT) 06.27.2011 HIPAA 5010.OCR Qualifier Changes Effective January 1, 2012 06.24.2011 PRTF Waiver Site Denial Required 04.12.2011 Request: Claims Submission, Date of Payment by June 30, 2011 2010 10.05.2010 Changes to NCCI Edits 09.15.2010 Unlinking Passport Providers No Longer Part of Group Practice 07.28.2010 Provider Record Update Procedures 07.15.2010 Vaccine Update Effective February 23, 2010 06.23.2010 Cost Sharing Exemption under ARRA 06.23.2010 Changes to the First Health Services Provider Manuals, Clinical Guidelines and Forms Used for Utilization Management of Children's Mental Health Medicaid Services 06.22.2010 Electronic Health Records Link 06.04.2010 Medicaid Consultation Services 05.28.2010 Clinical Laboratory Fee Schedule (CLFS) Instructions for Test Codes 80100, 80101, 80101 QW, G0430, G0430 QW, and G0431 QW 05.24.2010 Transplant Program Update Updated 05.24.2010 02.09.2010 United States 2010 Census 02.08.2010 Medicaid Health Improvement Program 01.21.2010 Reimbursement Change for Psychiatric Residential Treatment Facilities and How It Affects Other Montana Medicaid Providers Provider Notice 2001–2009 2009 10.01.2009 Healthy Montana Kids Plan 03.16.2009 Timely Filing for Medicare Crossovers 02.12.2009 Reimbursement Change for Psychiatric Residential Treatment Facilities and How It Affects Other Montana Medicaid Providers 2008 10.20.2008 Changes in Transplant Coverage 10.27.2008 08.12.2008 Federal Government May Request Medical Records 09.18.2008 05.29.2008 When to Submit an NDC (National Drug Code) If You Are Billing as a 340B Provider 05.22.2008 Frequently Asked Questions About NPI Reenrollment and Billing 06.17.2008 03.17.2008 Resubmission of Denied Claims 03.19.2008 03.10.2008 NPI Reenrollment and Billing 01.18.2008 Possible Duplicate Claims Processed Through Electronic Data Interchange 2007 12.17.2007 Enhanced Claims Editing – Assistant, Team, Co-Surgeon 12.17.2007 Enhanced Claims Editing – Multiple Evaluation and Management Services Provided on the Same Day 12.03.2007 NPI Requirement for Fee-for-Service Healthcare Provider Claims 11.27.2007 Cost Share Changes 11.01.2007 Enhanced Claims Editing – Add-On Codes 11.01.2007 Enhanced Claims Editing – New Visit Evaluation and Management Codes 11.01.2007 Enhanced Claims Editing Bloodhound ClaimsGuard® 08.01.2007 Elimination of eSOR 06.25.2007 NPI on the Web Portal 06.11.2007 Ownership and Control Information Required for Reenrollment 06.06.2007 NPI Contingency Plan Implemented, Reenrollment Extended 05.31.2007 New CMS-1500 to Be Required Beginning July 2, 2007 2000–2006 10.23.2006 Mileage Rate Increase 07.28.2005 Scales – Congestive Heart Failure 02.04.2005 Introduction to Preferred Drug List 06.10.2004 Team Care Program A New Component of the Passport to Health Program 08.29.2003 Passport to Health Implementation in Prairie County 08.29.2003 DMEPOS Advisory Workgroup Openings 08.20.2003 Submitting HIPAA Compliant Claims – Information for All Providers 07.01.2003 New Modifiers and Termination of Local Modifiers 05.12.2003 Provider Rate and Payment Update 01.10.2003 New Provider Notification Procedure and Medicaid Changes 10.01.2002 Billing for Medicare Crossovers After Medicare's 45-Day Response Time 07.01.2002 2.6% Reduction 02.14.2002 Weekly Payment Available 04.06.2000 Non-Emergency Ambulance Services for Medicare/Medicaid Clients Other Resources APR - DRG FAQ EOB R&R Crosswalk in PDF Format and EOB R&R Crosswalk in Excel Format 02.2011 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. Lab Panels 2007 01.2007 List of codes that make up lab panels for 2004–2007. Lab Panel Crosswalk 08.05.2003 CPT codes which make up organ or disease oriented panels and evocative. suppression testing. Outpatient Hospital Payment Summary 08.01.2003 Technical specifications for the new hospital outpatient payment method. Outpatient Prospective Payment System Billing Guide 08.28.2006 PowerPoint Presentation: Outpatient Prospective Billing Guide. If you do not have Microsoft PowerPoint, download PowerPoint Viewer Prior Authorization Criteria for Specific Services Rebateable Manufacturers 01/2017 SURS Provider Self-Audit Protocol 10.2015 The TPL Carrier Code List has been removed from this website, for questions or concerns related to the document please contact email@example.com. Thank you.