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Montana Healthcare Programs Provider Information » Dental (Dentist and Dental Hygienist)

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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

 

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, 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

Fee Schedules – Dentist

PDF

Excel

07.2016 July 2016 Dental 07.2016 July 2016 Dental
01.11.2016 January 2016 Dental 01.11.2016 January 2016 Dental
07.2015 July 2015 Dental 07.2015 July 2015 Dental
07.2014 July 2014 Dental 07.2014 July 2014 Dental
07.2013 July 2013 Dental 07.2013 July 2013 Dental
01.2013 January 2013 Dental 03.14.2013 01.2013 January 2013 Dental 03.14.2013
08.2011 August 2011 Dental 01.24.2012 08.2011 August 2011 Dental 01.24.2012
03.2011 January 2011 Dental 03.04.2011 03.2011 January 2011 Dental 03.04.2011
09.2010 July 2010 Dental 09.22.2010 09.2010 July 2010 Dental 09.22.2010
08.2010 July 2009 Dental 08.2010 July 2009 Dental
07.2008 July 2008 Dental 09.24.2008 07.2008 July 2008 Dental 09.24.2008
01.2008 January 2008 Dental 01.2008 January 2008 Dental
10.2007 October 2007 Dental 10.2007 October 2007 Dental
01.2007 January 2007 Dental 01.2007 January 2007 Dental
07.2006 July 2006 Dental 07.2006 July 2006 Dental
07.2005 July 2005 Dental 07.2005 July 2005 Dental
07.2004 July 2004 Dental 07.2004 July 2004 Dental
07.2003 July 2003 Dental 07.2003 July 2003 Dental
01.2003 January 2003 Dental 01.2003 January 2003 Dental
07.2002 July 2002 Dental 07.2002 July 2002 Dental
07.2001 July 2001 Dental 07.2001 July 2001 Dental

Fee Schedules – Dental Hygienist

Provider Notices 2010–

2017

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

2013

12.23.2013 Electronic Funds Transfer (EFT) and Electronic Remittance Advice (ERA) Changes Update
11.26.2013 ICD-10 Readiness
09.11.2013 Electronic Funds Transfer (EFT) and Electronic Remittance Advice (ERA) Changes
06.25.2013 Dental Reimbursement Rate Change, Updated Provider Manual, New Procedure Code, and New Prior Authorization Treatment Plan Form for Orthodontia
05.28.2013 DPHHS to Discontinue Temporary Hotline Number
04.16.2013 Changes to Coverage of Dental Procedure Codes D4271, D4277, and D4278
02.19.2013 Montana Medicaid HIPAA Operating Rules Upgrade
01.14.2013 Changes to Coverage of Dental Procedure Codes D1203, D1204, and D1208

2012

12.26.2012 Medicaid/HMK Plus Toll-Free Number
12.17.2012 American Medical Association Adopts New Psychiatric Diagnostic and Psychological Codes
09.10.2012 Preferred Drug List (PDL) Expansion
08.22.2012 Deleted ICD-9-CM Codes
07.30.2012 Prior Authorization Requirements for Crowns
07.30.2012 NPI Requirements for Pharmacy Claims Payment
07.27.2012 NCPDP D.0 Payer Sheet
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
09.09.2011 HIPAA 5010.OCR Qualifier Changes Effective January 1, 2012
09.07.2011 Payment Error Rate Measurement (PERM)
07.22.2011 Dental Reimbursement Rate Change and Prior Authorization Required for Certain Services
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
05.18.2011 Dental and Denturist Program Manual Updated
04.12.2011 Request: Claims Submission, Date of Payment by June 30, 2011

2010

12.27.2010 Dental and Denturist Covered Procedures and Reimbursement Update Effective 01.01.2011
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
05.25.2010 Medicaid Incentive Payment Program for Adopting Electronic Health Records
05.24.2010 Orthodontia Prior Authorization Reminder
02.09.2010 United States 2010 Census
02.09.2010 Dental and Denturist Manual and Fee Schedules
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

06.25.2009 Rate Increase

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

09.15.2008 Dental Sealant Revisions

09.03.2008 Tamper-Resistant Rx Pad Update: Three Features Required October 1

08.12.2008 Federal Government May Request Medical Records 09.18.2008

07.28.2008 Fee Schedule and Claim Form

07.10.2008 Multiple Conversion Factors for RBRVS Providers

06.24.2008 Revision to Procedure Code D3240

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

02.13.2008 Tamper-Resistant Prescription Pads

02.04.2008 Duplicate Issue Updated from 01.31.2008

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

12.06.2007 Dental Rates and Claim Forms

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

01.05.2006 Increased Reimbursement for EPSDT Preventive Services

07.28.2005 Scales – Congestive Heart Failure

04.11.2005 Dental Program Coverage Changes

02.04.2005 Introduction to Preferred Drug List

07.01.2004 Dental and Denturist Code Changes and Manual Update

06.10.2004 Prescription Drug Prior Authorization Additions

06.10.2004 Team Care Program A New Component of the Passport to Health Program

12.01.2003 Billing Other Health Insurance Before Medicaid

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

06.08.2003 Local Codes Terminated

05.12.2003 RBRVS Notice: Provider Rate and Payment Update

03.01.2003 Pharmacy Prior Authorization and Refill Changes

02.06.2003 Billing With CDT-4 Dental Codes

01.29.2003 Prescription Drug Services Update

01.15.2003 Dental Program Changes

01.10.2003 New Provider Notification Procedure and Medicaid Changes

01.02.2003 Prior Authorization Update

10.01.2002 Billing for Medicare Crossovers After Medicare's 45-Day Response Time

09.01.2002 Cost Sharing

07.01.2002 Dental Program Changes

07.01.2002 2.6% Reduction

02.14.2002 Weekly Payment Available

11.14.2001 Tooth Number Required for D1510 and D1515

10.17.2001 Dental Implants

06.01.2001 Global Surgery Periods Effective July 1, 2001

03.20.2000 Global Surgery Periods Effective May 1, 2000

Other Resources

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.
EOB R&R Crosswalk PDF Format and EOB R&R Crosswalk Excel Format 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.
Lab Panels 2007 01.2007
List of codes that make up lab panels for 2004–2007.
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 mttpl@xerox.com. Thank you.