Dental (Dentist and Dental Hygienist) Dental Dentist and Dental Hygienist Provider Manuals General Information for Providers 02/2017 Medicaid manual with general information for all provider types. Dental and Denturist Program Effective 07/2016 This manual has information specific to your provider type. Healthy Montana Kids (HMK) and CHIP Dental Services 01/2016 This manual has information specific to HMK and CHIP dental providers. 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 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 Dental and Denturist Program 06.08.2016 Dental and Denturist Services, July 2016 In summary the Cover Page had the date only changed, the Covered Services Limitations section had nearly all of pages 2.2 and 2.10 updated, and the Orthodontia Services and Requirements Section had the fee cap amount updated on page 3.5. 12.31.2015 Dental and Denturist Services, January 2016, HELP Plan-Related Updates and Others 07.01.2015 Dental and Denturist Services, July 2015: Entire Manual 07.01.2014 Dental and Denturist Services, July 2014 The manual has been streamlined. Information found elsewhere is not repeated in this manual; instead, a link to the source of the information is provided. 07.01.2013 Dental and Denturist Program, July 2013 This set of replacement pages includes the entire manual. Content changes are indicated by the addition of a change bar (black line). For a complete manual without the change bars, see the Provider Manuals section at the top of this page. 05.18.2011 Dental and Denturist Program, April 2011: Covered Services and Limitations and Orthodontia Services and Requirements 07.01.2005 Dental and Denturist Program, July 2005: Updated Fees 09.02.2004 Dental and Denturist Program, August 2004: Added "Per Quadrant" Requirements to Codes D4240–D4261 07.01.2004 Dental and Denturist Program, July 2004: Covered Services Update 07.02.2003 Dental and Denturist Program: July 2003: Procedure Limits and Requirements Table 07.01.2002 Dental and Denturist Program, July 2002: Covered Services and Limitations and Billing Procedures HMK and CHIP Dental 12.31.2015 HMK and CHIP Dental, January 2016, HELP Plan-Related Updates and Others 10.05.2015 HMK and CHIP Dental, September 2015: Entire Manual 01.14.2003 HMK and CHIP Dental Beginning in 2013, the format of the manual was changed. The manual was updated in July. 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 – Dentist 07/2016 PDF July 2016 Dental Excel July 2016 Dental 01/11/2016 PDF January 2016 Dental Excel January 2016 Dental 07/2015 PDF July 2015 Dental Excel July 2015 Dental 07/2014 PDF July 2014 Dental Excel July 2014 Dental Fee Schedules – Dental Hygienist 07/2016 PDF July 2016 Dental Hygienist Excel July 2016 Dental Hygienist 01/11/2016 PDF January 2016 Dental Hygienist Excel January 2016 Dental Hygienist 07/2015 PDF July 2015 Dental Hygienist Excel July 2015 Dental Hygienist 07/2014 PDF July 2014 Dental Hygienist Excel July 2014 Dental Hygienist Provider Notices 2017 05/26/2017 Federal Final Rule, "Nondiscrimination in Health Program and Activities” and Implication for Coverage of Services Related to Gender Transition 04/06/2017 New EPSDT Request Form 2016 07/16/2016 Changes to Member Cost Share Update 06/09/2016 Dental Reimbursement Rate Change and Updated provider Manual 05/19/2016 Changes to Member Cost Share 02/01/2016 Basic Medicaid Benefit Increased to Standard Medicaid Benefit 01/21/2016 Important Dental Benefit Update 01/15/2016 Standard Medicaid and HELP Plan Claims Processing Rev. 01/19/2016 2015 12/31/2015 Changes to Montana Medicaid 12/31/2015 Important Dental Benefit Update 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 08/07/2015 Identification of Referring Providers on ADA Claim Form and 837D X12 Transactions 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 07/13/2015 Dental Reimbursement Rate Change and Updated Provider Manual 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 08/22/2014 Tobacco Cessation Products 08/05/2014 Montana Prescription Drug Registry 07/01/2014 Dental Reimbursement Rate Change, Updated Provider Manual, New and Discontinued Procedure Codes, and New Dental Claim Form 06/17/2014 Healthy Montana Kids (HMK)/CHIP Dental Changes 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 Other Resources Dental Provider MDA Training Materials 05/2017 Dental Emergency Services Form 07/2013 This form must be completed and submitted with claims for emergency dental services provide to members age 21 and over with Basic Medicaid coverage. Sample ADA Dental Claim Form 06/2016 SURS Provider Self-Audit Protocol 10/2015 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 code Lab Panels 2007 01/2007 List of codes that make up lab panels for 2004–2007. To locate older documents, access the Archive Page.