Physical Therapist Physical Therapist Provider Manuals General Information for Providers 02/2017 Medicaid manual with general information for all provider types. Therapy Services 04.2017 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. 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 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 Therapy Services (Physical, Occupational, and Speech) 03/29/2017 Therapy Services, April 2017 In summary, the supervision requirements for various types of aides were clarified, telehealth for speech only was added, the cost share sections were updated, Montana Provider Relations, TPL, and Conduent as appropriate replaced Xerox, and the entire manual was prepared for the 508 conversion per the September 2016 Manuals meeting. 12.31.2015 Therapy Services, January 2016: HELP Plan-Related Updates and Others 09.09.2005 Therapy Services, August 2005: Revised Levels of Supervision for Therapists, New Place of Service Codes 04.11.2005 Therapy Services, April 2005: Updated Key Contacts Passport to Health 11.09.2015 Passport to Health, November 2015: Passport Referrals 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 – Physical Therapy PDF EXCEL 01/2017 January 2017 Physical Therapy 01/2017 January 2017 Physical Therapy 07.2016 July 2016 Physical Therapy Rev. 09/08.2016 07.2016 July 2016 Physical Therapy Rev. 09/08.2016 07.2015 July 2015 Physical Therapy 07.2014 July 2014 Physical Therapy 02.2014 January 2014 Physical Therapy 12.2013 December 2013 Physical Therapy 07.2013 July 2013 Physical Therapy 07.2012 July 2012 Physical Therapy 09.2011 September 2011 Physical Therapy 11.2011 01.2011 January 2011 Physical Therapy 07.2010 July 2010 Physical Therapy 07.2009 July 2009 Physical Therapy 01.2009 January 2009 Physical Therapy 07.2008 July 2008 Physical Therapy 10.2007 October 2007 Physical Therapy 01.2007 January 2007 Physical Therapist 07.2006 July 2006 Physical Therapist 01.2006 January 2006 Physical Therapist 07.2005 July 2005 Physical Therapist 01.2005 January 2005 Physical Therapist 07.2004 July 2004 Physical Therapist 01.2004 January 2003 Physical Therapist 07.2003 July 2003 Physical Therapist 01.2003 January 2003 Physical Therapist 07.2002 July 2003 Physical Therapist 01.2002 January 2002 Physical Therapist Provider Notices 2010–2016 2016 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 11.03.2015 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 06.22.2015 Identification of Ordering and Referring Providers on CMS-1500 and 837P X12 Transactions 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 Reimbursement Rate Changes 06.12.2014 ICD-10 Delay 05.13.2014 PERM Provider Educational Webinars 04.22.2014 Modifier Changes for Professional Claim Billers 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 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 10.27.2008 08.12.2008 Federal Government May Request Medical Records 09.18.2008 07.10.2008 Multiple Conversion Factors for RBRVS Providers 07.08.2008 Adjustment for Claims Using Multiple Conversion Factors 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 02.04.2008 Duplicate Issue Updated from 01.31.2008 01.29.2008 Enhanced Claims Editing—Medicare Correct Coding Initiative Edits (CCI) 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® 10.03.2007 Rendering Provider 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 12.22.2006 Prior Authorization for DMEPOS and Medical and Surgical Procedures Updated Phone and Fax Lines 11.08.2006 Prior Authorization on the Move 10.11.2005 Wheelchair CMNs – Transition Instructions 07.28.2005 Scales – Congestive Heart Failure 04.04.2005 Pricing Logic Changes for Professional (CMS-1500) Claims 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 05.12.2003 Provider Rate and Payment Update 01.10.2003 New Provider Notification Procedure and Medicaid Changes 01.10.2003 Therapy Service Limits 10.01.2002 Billing for Medicare Crossovers After Medicare's 45-Day Response Time 09.01.2002 Cost Sharing 07.01.2002 2.6% Reduction 06.20.2002 Passport to Health 24-Hour Availability 03.21.2002 Prior Authorization Reminders: DME, DMEPOS 02.14.2002 Weekly Payment Available 09.27.2000 Modifier Update 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.