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 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

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/



General Information For Providers, July 2016

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 0
7/31/2015  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 
04/13/2012 General Information for Providers, April 2012: Medicaid Covered Services and Client Eligibility
If information is found on the website, it has been removed from the manual, and a link to the source is provided/

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

Fee Schedules - Hospital - APR DRG


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


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


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


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


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


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 04/2017

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 Thank you.

To locate older documents, access the Archive Page.