Department of Public Health and Human Services

Montana Healthcare Programs Provider Information » Hospital Inpatient

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Hospital Inpatient

Hospital Inpatient

Provider Manuals

General Information for Providers  09/2017
Medicaid manual with general information for all provider types.
Hospital Inpatient Services  10/2017
This manual has information specific to your provider type.
Critical Access Hospitals 10/2017
This manual has information specific to critical access hospitals.

Medicaid Rules and Regulations

Fee Schedules - Hospital - APR DRG

APR - DRG FAQ

 

Some documents on this page are legal and/or historical in nature and cannot be altered to meet 508 Accessibility standards.  Each of those documents has a corresponding .txt document with the same name placed next to it.

October 2016

PDF: October 2016 APR-DRG Calculator Rev. 09/19/2017
Excel: October 2016 APR-DRG Calculator Rev. 09/19/2017
TEXT: October 2016 APR-DRG Calculator Rev. 09/19/2017

July 2015

PDF:July 2015 APR-DRG Rev. 04/22/2016
Excel:July 2015 APR-DRG Rev. 04/22/2016
TEXT: July 2015 APR-DRG Rev. 04/22/2016

 

 

 

 

 

 

Provider Notices

Some documents on this page are legal and/or historical in nature and cannot be altered to meet 508 Accessibility standards.  Each of those documents has a corresponding .txt document with the same name placed next to it.

2017

11/20/2017 Qualified Medicare Beneficiary (QMB) Claim Adjustments
11/13/2017 Smart PA® Prior Authorization for Synagis®
11/02/2017 New Medicare Card
10/02/2017 Montana Medicaid Expansion Changes
09/14/2017 Montana Plan First Anesthesia Update
08/21/2017 Clinical Pharmacist Practitioner
08/01/2017 Telemedicine - Correction
05/26/2017 Federal Final Rule, "Nondiscrimination in Health Program and Activities” and Implication for Coverage of Services Related to Gender Transition
05/15/2017 OOS Adult Acute Mental Health Inpatient Hospital Prior Authorizations
05/01/2017 Vaccine Administration Code Update
04/24/2017 Unlisted Services or Procedures Reminder
04/20/2017 Plan First Hysterectomy codes added effective April 1, 2017
04/06/2017 New EPSDT Request Form
04/04/2017 PA Criteria for Artificial Disc Replacement
04/04/2017 Criteria for Orthognathic Surgery
04/04/2017 Changes to Medical Surgical PA
04/04/2017 Criteria for Panniculectomy
02/23/2017 Mass Adjustment to Correct the Base Rate Calculation
02/02/2017 EPSDT ( Children's) Lead Screening Requirements

2016

PDF: 11/01/2016 Smart PA® for Synagis® Revised 11/15/2016
TXT:  11/01/2016 Smart PA® for Synagis® Revised 11/15/2016
PDF: 10/28/2016 ICD 10 Updates and Coding Changes Revised 12/07/2016
TXT:  10/28/2016 ICD 10 Updates and Coding Changes Revised 12/07/2016
PDF: 10/18/2016 Inpatient PPS Hospital Stays with Split Medicaid eligibility and the HELP TPA Plan through BCBS - Revised 10/21/2016
TXT:  10/18/2016 Inpatient PPS Hospital Stays with Split Medicaid eligibility and the HELP TPA Plan through BCBS - Revised 10/21/2016
PDF: 09/27/2016 Physician Administered Drugs - NDC Requirements Revised
TXT:  09/27/2016 Physician Administered Drugs - NDC Requirements Revised
PDF: 07/28/2016 Montana Plan First Preventive Code Additions
TXT:  07/28/2016 Montana Plan First Preventive Code Additions
PDF: 07/25/2016 Admission Date and Statement Covers Period - Revised 07/18/2016
TXT:  07/25/2016 Admission Date and Statement Covers Period - Revised 07/18/2016
PDF: 07/18/2016 Changes to Member Cost Share Update
TXT:  07/18/2016 Changes to Member Cost Share Update
PDF: 07/12/2016 Vaccine Administration Code Update
TXT:  07/12/2016 Vaccine Administration Code Update
PDF: 07/05/2016 PA For Botox No Longer Required
TXT:  07/05/2016 PA For Botox No Longer Required
PDF: 07/05/2016 Circumcision Prior Authorization Changes
TXT:  07/05/2016 Circumcision Prior Authorization Changes
PDF: 07/01/2016 Admission Date and Statement Covers Period
TXT:  07/01/2016 Admission Date and Statement Covers Period
PDF: 05/19/2016 Changes to Member Cost Share
TXT:  05/19/2016 Changes to Member Cost Share
PDF: 02/01/2016 Basic Medicaid Benefit Increased to Standard Medicaid Benefit
TXT:  02/01/2016 Basic Medicaid Benefit Increased to Standard Medicaid Benefit
PDF: 01/28/2016 LARC Inserted at Time of Delivery in PPS Hospital
TXT:  01/28/2016 LARC Inserted at Time of Delivery in PPS Hospital
PDF: 01/15/2016 Standard Medicaid and HELP Plan Claims Processing Rev/ 01/19/2016
TXT:  01/15/2016 Standard Medicaid and HELP Plan Claims Processing Rev/ 01/19/2016
PDF: 01/15/2016 Hospital Grade Electric Breast Pump Requirements
TXT:  01/15/2016 Hospital Grade Electric Breast Pump Requirements

2015

PDF: 12/31/2015 Changes to Montana Medicaid
TXT:  12/31/2015 Changes to Montana Medicaid
PDF: 12/30/2015 Addictive and Mental Disorders Division Changes to Prior Authorization
TXT:  12/30/2015 Addictive and Mental Disorders Division Changes to Prior Authorization
PDF: 11/23/2015 Prior Authorization Requests and Medical-Surgical Prior Authorization Request Form Rev/ 12/2015
TXT:  11/23/2015 Prior Authorization Requests
PDF: 11/18/2015 Hospital National Drug Code (NDC) Billing on Revenue Codes Rev/ 12/21/2015
TXT:  11/18/2015 Hospital National Drug Code (NDC) Billing on Revenue Codes Rev/ 12/21/2015
PDF: 11/03/2015 Services Exempt from Passport to Health Referral
TXT:  11/03/2015 Services Exempt from Passport to Health Referral
PDF: 10/21/2015 ICD-10 Obstetric Observation Billing
TXT:  10/21/2015 ICD-10 Obstetric Observation Billing
PDF: 10/21/2015 SmartPA® Prior Authorization for Synagis®
TXT:  10/21/2015 SmartPA® Prior Authorization for Synagis®
PDF: 10/09/2015 Montana Plan First – ICD-10 Update
TXT:  10/09/2015 Montana Plan First – ICD-10 Update
PDF: 10/01/2015 Changes to the Children's Mental Health Bureau Medicaid Services Provider Manual
TXT:  10/01/2015 Changes to the Children's Mental Health Bureau Medicaid Services Provider Manual
PDF: 08/19/2015 Identification of Ordering and Referring Providers on UB-04 and 837I X12 Transactions
TXT:  08/19/2015 Identification of Ordering and Referring Providers on UB-04 and 837I X12 Transactions
PDF: 08/17/2015 Medicare Crossover Claims With Medicare Non-Covered Charges That Medicaid Allows
TXT:  08/17/2015 Medicare Crossover Claims With Medicare Non-Covered Charges That Medicaid Allows
PDF: 08/03/2015 ICD-10 Guidance for Implementing International Classification of Diseases, 10th Edition (ICD-10)
TXT:  08/03/2015 ICD-10 Guidance for Implementing International Classification of Diseases, 10th Edition (ICD-10)
PDF: 07/31/2015 Adult and Pediatric Specialty Table of Services Available in Montana
TXT:  07/31/2015 Adult and Pediatric Specialty Table of Services Available in Montana
PDF: 07/08/2015 Montana Plan First – Revised List of Plan First Covered Services
TXT:  07/08/2015 Montana Plan First – Revised List of Plan First Covered Services
PDF: 03/11/2015 Criteria for Breast Reconstruction
TXT:  03/11/2015 Criteria for Breast Reconstruction
PDF: 03/11/2015 Criteria for Prophylactic Mastectomy
TXT:  03/11/2015 Criteria for Prophylactic Mastectomy
PDF: 02/11/2015 New HCPCS Modifiers – XE, XP, XS, and XU
TXT:  02/11/2015 New HCPCS Modifiers – XE, XP, XS, and XU
PDF: 01/30/2015 Telehealth Diagnosis Codes
TXT:  01/30/2015 Telehealth Diagnosis Codes
PDF: 01/07/2015 Long Acting Reversible Contraception (LARC) Inserted at Time of Delivery in a PPS Hospital
TXT:  01/07/2015 Long Acting Reversible Contraception (LARC) Inserted at Time of Delivery in a PPS Hospital

Other Resources

APR - DRG FAQ

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  10/2017

SURS Provider Self-Audit Protocol 10.2015

 

To locate older documents, access the Archive Page.