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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

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

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.