EPSDT EPSDT / Children’s Services Early and Periodic Screening, Diagnostic, and Treatment Services Please note: If you require Children's Chiropractic (EPSDT) information visit the Children's Chiropractic (EPSDT) provider type. Provider Manuals General Information for Providers 02/2017 Medicaid manual with general information for all provider types. This manual has information specific to your provider type. Nutrition EPSDT 01.2016 This manual has information specific to your provider type. Orientation and Mobility Specialist 08.2013 This manual has information specific to your provider type. Physician-Related Services 11/2016 This manual has information specific to your provider type. Private Duty Nursing EPSDT 01.2016 This manual has information specific to your provider type. 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. 09/12/2016 In summary, the entire manual has undergone formatting changes, the Billing Procedures section has had some minor language changes and the Cover reflects the current date. 08.02.2016 Introduction contains updated links in the HELP section. Cost Share was updated in the Billings Procedure. A duplicate word was removed in the RA chapter. The Cover Page was changed to reflect the current date of the new General Manual revision. 07.12.2016 General Information For Providers, July 2016 Table of Contents was amended by changing the title of “Basic Medicaid Waiver” to “Waiver for Additional Services and Populations (formerly Basic Medicaid Waiver)”. Index was amended by changing the title of “Basic Medicaid Waiver” to “Waiver for Additional Services and Populations (formerly Basic Medicaid Waiver)”. Page 1.3 changed the title “Basic Medicaid Waiver for Additional Services and Populations” to “Waiver for Additional Services and Populations (formerly Basic Medicaid Waiver)” 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, June 2014: Member Eligibility and Responsibilities, Presumptive Eligibility 06.30.2014 General Information for Providers, June 2014: Entire Manual 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 04.29.2005 General Information for Providers, April 2005: Member Number a Billable Number and Key Contacts Updated 11.05.2004 General Information for Providers, November 2004: References to Medicaid Rules and Regulations Added 09.16.2004 General Information for Providers, September 2004: Team Care and Nurse First Information Added Nutrition (EPSDT) 12.31.2015 Nutrition Services, January 2016: HELP Plan-Related Updates and Others Private Duty Nursing (EPSDT) 12.31.2015 Private Duty Nursing Services, January 2016: HELP Plan-Related Updates and Others Physician-Related Services 11/28/2016 In summary, the Page 5.6 of the Billing Procedures chapter was amended to add information for locum tenens, several links were updated, and two blank pages were removed. The Table of Contents and Index sections were adjusted, several links were updated in the Introduction and Covered Services Chapter, the entire manual was formatted as approved by the September 2016 Manuals Meeting for initial 508 adaptations, and the Cover page was amended with the current date. 09/12/2016 In summary, the entire manual has undergone formatting changes, the Billing Procedures section has had some minor language changes and the Cover reflects the current date. 08.31.2016 In summary, The cost share section was removed from the Billing Procedures Chapter, related entries were removed from the Index Section adjustments were made to the Index Section , and the date was changed on the Cover Page. 07.31.2015 Physician-Related Services, August 2015: Entire Manual, Removed EPSDT Well-Child 07.08.2014 Physician-Related Services, July 2014: Multiple Chapters 07.14.2008 Physician-Related Services, March 2008: Key Contacts, Completing a Claim Form, Prior Authorization, Billing for Immunizations 07.25.2006 Physician-Related Services, July 2006: Well-Child EPSDT Update 04.25.2006 Physician-Related Services, April 2006: Revised Instructions for Completing a Claim, Revised Information on How Cost-Sharing Affects Claim Payment 01.05.2006 Physician-Related Services, September 2005: New EPSDT, Hysterectomy Acknowledgement Form, Revised Information on Imaging Modifiers, Billing for Immunizations, and ER Visits for Clients Under Age 2 03.01.2005 Physician-Related Services, March 2005: Hysterectomy Acknowledgement Update 01.25.2005 Physician-Related Services, January 2005: Rule References Added, Updates to Covered Services, PA and Modifiers 11.16.2004 Physician-Related Services, November 2004: Updated Prescription Drug PA Criteria 09.15.2004 Physician-Related Services, September 2004: Team Care Added 06.16.2004 Physician-Related Services, July 2004: Clarification on Sterilizations, Hysterectomies, Abortions and HIPAA and Drug PA Update 12.23.2003 Physician-Related Services, December 2003: Immunizations, PA Criteria, Family Planning, and Using Modifiers 09.16.2003 Physician-Related Services, September 2003: Hysterectomies and Prescription Drug PA Update 08.20.2003 Physician-Related Services, June 2003: New Emergency Services Policy and Hard Card Information 07.28.2003 Physician-Related Services, Hysterectomy Requirements 06.01.2003 Physician-Related Services, New PA Requirements and Hysterectomy Information 01.02.2003 Physician-Related Services, January 2003: Prior Authorization 09.01.2002 Physician-Related Services, September 2002: Cost Sharing 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 – Children's Special Health Services 07.2014 July 2014 Children's Special Health Services – Interdisciplinary Teams Fee Schedules - Nutritionist (EPSDT) PDF Excel 07.2016 July 2016 Nutrition Rev 02/02/2016 07.2016 July 2016 Nutrition Rev 02/02/2016 07.2015 July 2015 Nutrition 07.2014 July 2014 Nutrition 12.2013 December 2013 Nutrition 07.2013 July 2013 Nutrition 07.2011 August 2011 Nutrition 07.2009 July 2009 Nutrition 07.2008 July 2008 Nutrition 07.2006 July 2006 Nutrition 01.2006 January 2006 Nutrition 07.2004 July 2004 Nutrition 01.2004 January 2004 Nutrition 07.2003 July 2003 Nutrition 01.2003 January 2003 Nutrition 07.2002 July 2002 Nutrition Fee Schedules – O&M Specialist PDF EXCEL 07.2016 July 2016 Orientation and Mobility 07.2016 July 2016 Orientation and Mobility 07.2015 July 2015 Orientation and Mobility Rev. 11.2015 07.2014 July 2014 Orientation and Mobility 07.2013 July 2013 Orientation and Mobility Fee Schedules – Private Duty Nursing PDF 07.2016 July 2016 Private Duty Nursing 07.2016 July 2016 Private Duty Nursing 07.2015 July 2015 Private Duty Nursing 07.2014 July 2014 Private Duty Nursing 07.2013 July 2013 Private Duty Nursing 07.2011 July 2011 Private Duty Nursing 07.2009 July 2009 Private Duty Nursing 07.2008 July 2008 Private Duty Nursing 01.2007 January 2007 Private Duty Nursing 01.2006 January 2006 Private Duty Nursing 08.2005 August 2005 Private Duty Nursing 01.2005 January 2005 Private Duty Nursing 01.2004 January 2004 Private Duty Nursing 01.2003 January 2003 Private Duty Nursing Fee Schedules – Respiratory PDF 07.2014 July 2014 Respiratory Therapy 01.2014 January 2014 Respiratory Therapy 07.2013 July 2013 Respiratory Therapy 01.2013 January 2013 Respiratory Therapy 07.2012 July 2012 Respiratory Therapy 01.2012 January 2012 Respiratory Therapy 01.2011 January 2011 Respiratory Therapy 07.2010 July 2010 Respiratory Therapy 07.2009 July 2009 Respiratory Therapy 01.2009 January 2009 Respiratory Therapy 01.2007 January 2007 Respiratory Therapy 07.2006 July 2006 Respiratory Therapy 07.2001 July 2001 Respiratory Therapy Provider Notices 2010– 2017 04/21/2017 Bowl Management Program Supplies 04/06/2017 New EPSDT Request Form 03/31/2017 Ketone Test Strips - A4250 & A252 02/07/2017 New Place of Service for Telehealth 02/02/2017 EPSDT ( Children's) Lead Screening Requirements 2016 09/26/2016 Coverage of Weighted Blankets 07.18.2016 Changes to Member Cost Share Update 05.19.2016 Changes to Member Cost Share 02.01.2016 Basic Medicaid Benefit Increased to Standard Medicaid Benefit 01.15.2016 Standard Medicaid and HELP Plan Claims Processing Rev. 01.19.2016 2015 12.31.2015 Changes to Montana Medicaid 11.13.2015 Oral Nutrition for Children Under Age 21 – EPSDT 11.03.2015 Services Exempt from Passport to Health Referral 10.01.2015 Changes to the Children's Mental Health Bureau Medicaid Services Provider Manual 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 02.11.2015 New HCPCS Modifiers – XE, XP, XS, and XU 2014 12.18.2014 Electronic Funds Transfer (EFT) and Electronic Remittance Advice (ERA) Changes Final Notice 09.16.2014 Adoption of the New Children's Mental Health Bureau's Medicaid Provider Manual into Administrative Rules of Montana 08.05.2014 Montana Prescription Drug Registry 06.27.2014 Orientation and Mobility Specialists: Reimbursement Rate Changes and New Method of Payment 06.12.2014 ICD-10 Delay 05.13.2014 PERM Provider Educational Webinars 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 11.07.2013 Medicaid Passport to Health Referrals and Fee Schedules 09.11.2013 Electronic Funds Transfer (EFT) and Electronic Remittance Advice (ERA) Changes 09.10.2013 New Services for Orientation and Mobility (O&M) Specialists for Schools 05.28.2013 DPHHS to Discontinue Temporary Hotline Number 02.19.2013 Montana Medicaid HIPAA Operating Rules Upgrade 2012 12.26.2012 Medicaid/HMK Plus Toll-Free Number 08.22.2012 Deleted ICD-9-CM Codes 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 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 06.27.2011 HIPAA 5010 / OCR Qualifier Changes Effective January 1, 2012 04.12.2011 Request: Claims Submission, Date of Payment by June 30, 2011 2010 10.05.2010 Changes to NCCI Edits 07.28.2010 Provider Record Update Procedures 06.23.2010 Cost Sharing Exemption under ARRA 06.23.2010 Resource-Based Relative Value Scale (RBRVS) Information 06.22.2010 Electronic Health Records Link 02.09.2010 United States 2010 Census 01.21.2010 Reimbursement Change for Psychiatric Residential Treatment Facilities and How It Affects Other Montana Medicaid Providers Provider Notices 2000–2009 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 Rev. 10.27.2008 08.12.2008 Federal Government May Request Medical Records Rev. 09.18.2008 07.10.2008 Multiple Conversion Factors for RBRVS Providers 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 Rev. 06.17.2008 03.17.2008 Resubmission of Denied Claims Rev. 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 07.25.2006 Replacement Pages Physician-Related Services Well-Child EPSDT Update 07.14.2006 EPSDT Private Duty Nursing Service Changes 01.05.2006 Increased Reimbursement for EPSDT Preventive Services 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 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 06.20.2002 Passport to Health 24-Hour Availability 02.14.2002 Weekly Payment Available 06.01.2001 Global Surgery Periods Effective 07.01.2001 03.20.2000 Global Surgery Periods Effective 05.01.2000 Other Resources EOB R&R Crosswalk PDF and EOB R&R Crosswalk Excel 02.2011 With the implementation of HIPAA, Medicaid discontinued the use of Medicaid EOB codes and began using HIPAA standard reason and remark (R&R) codes. This document crosswalks the HIPAA standard R&R codes to the Medicaid EOB codes. 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 firstname.lastname@example.org. Thank you.