Hospital Inpatient Hospital Inpatient Provider Manuals General Information for Providers 09/2017 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. 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 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 2017 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 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 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 1 0/20/2014 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 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 07/2017 SURS Provider Self-Audit Protocol 10.2015 To locate older documents, access the Archive Page.