Department of Public Health and Human Services

Montana Healthcare Programs Provider Information » Hospital Inpatient

Main Content

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.

Medicaid Rules and Regulations

Fee Schedules - Hospital - APR DRG

APR - DRG FAQ

October 2016

PDF: October 2016 APR-DRG Calculator
Excel: October 2016 APR-DRG Calculator

July 2015

PDF:July 2015 APR-DRG Rev. 04.22.2016
Excel:July 2015 APR-DRG Rev. 04.22.2016

July 2014

PDF: July 2014
Excel: July 2014

 

 

 

 

Provider Notices

2017

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.