Family Planning Family Planning Provider Manuals General Information for Providers 02/2017 Medicaid manual with general information for all provider types. Physician-Related Services 11/2016 This manual has information specific to your provider type. Provider Manuals – Replacement Pages General Information for Providers 02/07/2017 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 The 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 Physician-Related Services 11/28/0216 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 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 – Family Planning Family Planning Fee Schedule Information Payment of Family Planning services is based on the fee schedule for the provider type performing the service. If the member has Medicaid, please review the fee schedule for the specific provider type performing the service to determine whether the service is covered. If the member has Plan First coverage, please review the Service Code List found on the Plan First Page http://medicaidprovider.mt.gov/planfirst. Plan First is subject to all Montana Medicaid fees and policies. PDF and Excel 07.2015 July 2015 Family Planning PDF 01.2015 January 2015 Family Planning 01.2015 January 2015 Family Planning 07.2014 July 2014 Family Planning 07.2014 July 2014 Family Planning 02.2014 January 2014 Family Planning 02.2014 January 2014 Family Planning 07.2013 July 2013 Family Planning 07.2013 July 2013 Family Planning 07.2013 January 2013 Family Planning 01.2013 January 2013 Family Planning 07.2012 July 2012 Family Planning FY 2013 07.2012 July 2012 Family Planning FY 2013 01.2012 January 2012 Family Planning 01.2012 January 2012 Family Planning 09.2011 September 2011 Family Planning Revised 11.2011 09.2011 September 2011 Family Planning Revised 11.2011 02.2011 January 2011 Family Planning 02.2011 January 2011 Family Planning 07.2010 July 2010 Family Planning 07.2010 July 2010 Family Planning 02.2010 January 2010 Family Planning 02.2010 January 2010 Family Planning 07.2009 July 2009 Family Planning 07.2009 July 2009 Family Planning 01.2009 January 2009 Family Planning 01.2009 January 2009 Family Planning 07.2008 July 2008 Family Planning 07.2008 July 2008 Family Planning 01.2008 January 2008 Family Planning 01.2008 January 2008 Family Planning 10.2007 October 2007 Family Planning 10.2007 October 2007 Family Planning 01.2007 January 2007 Family Planning 01.2007 January 2007 Family Planning 07.2006 July 2006 Family Planning 07.2006 July 2006 Family Planning 01.2006 January 2006 Family Planning 01.2006 January 2006 Family Planning 07.2005 July 2005 Family Planning 07.2005 July 2005 Family Planning 01.2005 January 2005 Family Planning 01.2005 January 2005 Family Planning 01.2004 January 2004 Family Planning 01.2004 January 2004 Family Planning 07.2003 July 2003 Family Planning 07.2003 July 2003 Family Planning 01.2002 January 2002 Family Planning 01.2002 January 2002 Family Planning Provider Notices 2010– 2017 02/02/2017 EPSDT ( Children's) Lead Screening Requirements 2016 11/10/2016 Vaccines For Children Administration Update 07.28.2016 Montana Plan First Preventive Code Additions 07.18.2016 Changes to Member Cost Share Update 05.19.2016 Changes to Member Cost Share 04.07.2016 Montana Plan First - IUD and Anesthesia Updates 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 10.09.2015 Montana Plan First – ICD-10 Update 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 07.08.2015 Montana Plan First – Revised List of Plan First Covered Services 06.19.2015 Vaccine Administration Code Update 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 10.08.2014 Vaccine Administration Code Update 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 06.12.2014 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 01.28.2014 Vaccine Administration Code 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 09.24.2013 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) 06.20.2013 Montana Plan First – Additional Information 05.28.2013 DPHHS to Discontinue Temporary Hotline Number 05.13.2013 Montana Plan First – Revised List of Plan First Covered Services 02.25.2013 Vaccine Administration Changes 02.19.2013 Montana Medicaid HIPAA Operating Rules Upgrade 02.11.2013 Montana Plan First Additional Information Updated 2012 12.26.2012 Medicaid/HMK Plus Toll-Free Number 08.22.2012 Deleted ICD-9-CM Codes 06.11.2012 Plan First Effective June 1, 2012 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 10.07.2011 Influenza Virus Vaccine 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 06.24.2011 PRTF Waiver Site Denial Required 06.01.2011 17-AHP and Makena 04.12.2011 Request: Claims Submission, Date of Payment by June 30, 2011 02.07.2011 Vaccine Administration Code Update 2010 11.17.2010 17-AHP 11.17.2010 Compound Drugs Billed on a CMS-1500 10.05.2010 Changes to NCCI Edits 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 Resource-Based Relative Value Scale (RBRVS) Information 06.22.2010 Electronic Health Records Link 05.28.2010 Clinical Laboratory Fee Schedule (CLFS) Instructions for Test Codes 80100, 80101, 80101 QW, G0430, G0430 QW, and G0431 QW 02.11.2010 Family Planning Clinic Billing Opportunity Will Expire on August 1, 2010 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 2002–2009 2009 10.08.2009 2009 H1N1 Influenza Vaccine and Administration 10.15.2009 10.01.2009 Healthy Montana Kids Plan 09.22.2009 NDC Billing Tools 07.28.2009 Family Planning Clinic Medicaid Billing Changes 06.02.2009 Clarification of Required NDC Information for Coverage of 17 Alpha-Hydroxyprogesterone Caproate (17-AHP) 03.16.2009 Timely Filing for Medicare Crossovers 02.25.2009 Vaccines for Children (VFC) Effective as of October 10, 2008 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 07.22.2008 Billing Procedures Regarding Electronic Claims (837P and 837I) 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 06.17.2008 04.10.2008 Billing Procedures Regarding National Drug Code (NDC) for Providers Using the CMS-1500 and 837-P 03.17.2008 Resubmission of Denied Claims 03.19.2008 03.11.2008 Billing Procedures Regarding National Drug Code (NDC) 10.15.2008 03.10.2008 NPI Reenrollment and Billing 02.19.2008 New HCPCS and CPT Codes 01.18.2008 Possible Duplicate Claims Processed Through Electronic Data Interchange 01.11.2008 Vaccines for Children (VFC) 2007 12.28.2007 New Codes for Smoking and Tobacco Use Cessation Counseling 12.26.2007 WINASAP Upgrade Required for NDC Data Collection 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 11.30.2007 NDC Requirement on All Physician-Administered Drugs 01.17.2008 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 VFC Update 09.28.2007 Smoking and Tobacco Use Cessation Counseling 08.01.2007 Elimination of eSOR 07.06.2007 Coverage of 17 Alpha-Hydroxyprogesterone Caproate 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 04.16.2007 VFC Update (Updated from 01.24.2007) 04.16.2007 Coverage of HPV Vaccine 03.08.2007 New and Deleted Codes 2006 12.22.2006 Prior Authorization for DMEPOS and Medical/Surgical Procedures Updated Phone and Fax Lines 11.08.2006 Prior Authorization on the Move 09.22.2006 VFC Update 04.18.2006 VFC Update 03.01.2006 VFC Update 02.10.2006 New and Deleted Codes 01.05.2006 Increased Reimbursement for EPSDT Preventive Services 2005 09.26.2005 Blood Draws (CPT 36415 and 36416) 09.22.2005 Telemedicine 07.28.2005 Scales – Congestive Heart Failure 07.01.2005 VFC Update 06.01.2005 Medicaid Coverage Update 02.04.2005 Introduction to Preferred Drug List 02.01.2005 New and Deleted Codes and New Botox Criteria 2002–2004 06.10.2004 Team Care Program A New Component of the Passport to Health Program 02.01.2004 New and Deleted Codes 01.01.2004 VFC Changes Updated from 12.2003 12.01.2003 Bilateral X-Ray Reimbursement Update 12.01.2003 High Risk Pregnant Women (HRPW) Changes 12.01.2003 Expanded Botox Criteria 12.01.2003 VFC Changes 12.01.2003 Discontinued Local Codes 11.10.2003 EMTALA Policy Change 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 03.01.2003 Pharmacy Prior Authorization and Refill Changes 03.01.2003 New and Deleted HCPCS and CPT Codes 01.29.2003 Prescription Drug Services Update 01.10.2003 New Provider Notification Procedure and Medicaid Changes 12.01.2002 Program Changes and Updates 10.01.2002 Billing for Medicare Crossovers After Medicare's 45-Day Response Time 09.26.2002 DME Update 09.01.2002 Cost Sharing 07.01.2002 2.6% Reduction 06.20.2002 PASSPORT To Health 24-Hour Availability 02.14.2002 Weekly Payment Available Other Resources Prior Authorization Criteria for Specific Services EOB R&R Crosswalk and EOB R&R Crosswalk 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. Plan First Medicaid Non-Covered Agreement 07.2012 Rebateable Manufacturers 01/2017 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 firstname.lastname@example.org. Thank you.