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Hospital Inpatient

Provider Manuals

General Information for Providers 08.2016
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

08.02.2016

07.12.2016

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
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

Fee Schedules - Hospital - APR DRG

Provider Notices 2010–2016

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

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 04.2016

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 mttpl@xerox.com. Thank you.