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Hospital Outpatient

Hospital Outpatient

Provider Manuals

General Information for Providers 02/2017
Medicaid manual with general information for all provider types.
Hospital Outpatient 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.
Passport to Health 11/2015
Everything a provider needs to know to become a successful Passport provider
Rebateable Manufacturers 04/2017

 

 

Provider Manuals – Replacement Pages

General Information for Providers

02/06/2017 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.

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

Hospital Outpatient Services

12.31.2015 Hospital Outpatient Services, January 2016: HELP Plan-Related Updates and Others
11.17.2015 Hospital Outpatient Services, November 2015: Billing Procedures, Revenue Codes 25X and 27X
06.22.2015 Hospital Outpatient Services, May 2015: Entire Manual
07.05.2013 Hospital Outpatient Services, July 2013: Definitions and Index
06.27.2012 Hospital Outpatient Services, June 2012: Covered Services, Billing Procedures, How Payment Is Calculated
01.12.2012 Hospital Outpatient Services, December 2011: Hospital Outpatient Services
04.29.2011 Hospital Outpatient Services, April 2011: How Payment Is Calculated
12.16.2005 Hospital Outpatient Services, October 2005: New Instructions on Completing Medicaid Hysterectomy Acknowledgement Form
09.22.2004 Hospital Outpatient Services, August 2004: Team Care Added, Clarification on Sterilizations, Hysterectomies, Abortions, and MPQHF Phone Number Change

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

Passport to Health

11.09.2015 Passport to Health, November 2015: Passport Referrals

Medicaid Rules and Regulations

Fee Schedules – APC

04/27/2017 April 2017 APC Cover Sheet   April 2017 APC Fee Schedule PDF April 2017 APC Fee Schedule Excel

01/26/2017 PDF January 2017 APC Excel January 2017 APC
10/25/2016 PDF  October 2016 APC Excel October 2016 APC
07/21/2016  PDF July 2016 APC Excel  July 2016 APC
07/21/2016 PDF April 2016 APC Excel April 2016 APC
02/05/2016 PDF January 2016 APC Rev 04/26/2016 Excel January 2016 APC Rev 04/26/2016
10/20/2015 PDF  October 2015 APC Excel   October 2015 APC
08/03/2015 PDF July 2015 APC 08/03/2015 July 2015 APC
05/05/2015 PDF April 2015 APC Excel April 2015 APC
02/2015  PDF January 2015 APC Excel January 2015 APC
10/2014 PDF October 2014 APC Excel October 2014 APC
07/2014 PDF July 2014 APC Excel July 2014 APC
05/12/2014 PDF  April 2014 APC Excel April 2014 APC
01/31/2014 PDF  January 2014 APC Excel January 2014 APC

 

 

Fee Schedules – ATP Tests and Fees

01/17/2017  PDF January 2017 ATP  EXCEL January 2017 ATP
12/24/2015 January 2016 ATP  
01/2015 January 2015 ATP  
01/2014 January 2014 ATP                                  

Fee Schedules – Clinical Laboratory (CLAB)

Fee Schedules – Outpatient Procedure (OPP) Codes

04/27/2017  April 2017 OPP Cover Sheet     April 2017 OPP Fee Schedule PDF     April 2017 OPP Fee Schedule Excel

 

 01/26/2017PDF January 2017 OPP Codes 01/26/2017 EXCEL  January 2017 OPP Codes
10/25/2016 PDF  October 2016 OPP Codes 10/25/2016 EXCEL   October 2016 OPP Codes
07/21/2016 PDF July OPP Codes Rev 07/26/2016 EXCEL  July OPP Codes Rev 07/26/2016
05/12/2016 PDF April OPP Codes Rev 07/11/2016 EXCEL  April 2016 OPP Codes  Rev 07/11/2016
02/05/2016 PDF January 2016 OPP Codes Rev 05/12/2016 EXCEL  January 2016 OPP Codes Rev 05/12/2016
10/20/2015 PDF October 2015 OPP Codes Rev 11/2015 EXCEL  October 2015 OPP Codes Rev 11/2015
08/03/2015 PDF July 2015 OPP Codes Rev02/11/2016 EXCEL  July 2015 OPP Codes Rev 02/11/2016
05/05/2015 PDF April 2015 OPP Codes 05/05/2015 EXCEL  April 2015 OPP Codes
02/2015 PDF January 2015 OPP Codes EXCEL  January 2015 OPP Codes
10/2014 PDF October 2014 OPP Codes Rev EXCEL  October 2014 OPP Codes Rev
07/2014 PDF July 2014 OPP Codes Rev EXCEL  July 2014 OPP Codes Rev
05/2014 PDF  April 2014 OPP Codes Rev EXCEL  April 2014 OPP Codes Rev
01/2014 PDF  January 2014 OPP Codes EXCEL  January 2014 OPP Codes

 

 

Provider Notices

2017

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
03/16/2017  Physician Administered Drugs - Update
02/02/2017 EPSDT ( Children's) Lead Screening Requirements

02/02/2017 Change to Medicaid Outpatient Lab Billing

2016

12/08/2016 Physician Administered Drugs - Local Anesthetics
11/03/2016 Smart PA® for Synagis® Revised 11/15/2016
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
04/07/2016 Montana Plan First - IUD and Anesthesia Updates
04/05/2016 Place of Service Code Change
03/21/2016 NDC Required for Physician-Administered Drugs: Billing Instructions for Montana Medicaid Crossover Claims
03/02/2016 ICD-10 Obstetric Observation Billing Update Revised 03/01/2016
02/22/2016 Hospital NDC Billing on Revenue Codes and Electronic Claim Submission Denials
02/10/2016 ICD-10 Obstetric Observation Billing Update
02/01/2016 Basic Medicaid Benefit Increased to Standard Medicaid Benefit
01/28/2016 LARC Inserted at Time of Delivery in PPS Hospital
01/25/2016 Hospital National Drug Code (NDC) Billing on Revenue Codes
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
12/09/2015 Increasing Coverage of Lactation Services to Outpatient Hospitals
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
07/21/2015 Discarded Drugs and Biologicals and the Use of the JW Modifier
07/08/2015 Montana Plan First – Revised List of Plan First Covered Services
06/26/2015 Vaccine Administrative Code Update
06/09/2015 National Drug Code (NDC) Billing
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
06/25/2014 Medicaid Outpatient Lab Billing
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
03/18/2014 Billing Multiple Same-Day Visits on a UB-04 or 837I and Condition Code G0
02/28/2014 Medicaid Outpatient Laboratory Billing  Rev
01/29/2014 Centers for Medicare and Medicaid Services (CMS) ICD-10 Provider Readiness Assessment Update
01/17/2014 Medicaid and G-Codes See Update 04/02/2014
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

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 01/2017

SURS Provider Self-Audit Protocol 1/2015

 

To locate older documents, access the Archive Page.