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Optician

Optician

Provider Manuals

General Information for Providers 02/2017

Medicaid manual with general information for all provider types.

Optometric and Eyeglass Services 01.2016

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

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: Medicaid Covered Services and Client Eligibility

Optometric and Eyeglass Services

12.31.2015 Optometric and Eyeglass Services, January 2016: HELP Plan-Related Updates and Others

06.24.2015 Optometric and Eyeglass Services, June 2015: Entire Manual

(Note: There are pages that have no text changes; however, the page layout is different than the previous manual due to changes on previous pages.)

08.11.2014 Optometric and Eyeglass Services, August 2004: Entire Manual

Information contained in the General Information for Providers manual or found elsewhere on the website has been removed, and links to those sources are included.

05.19.2010 Optometric and Eyeglass Services, May 2010: Key Contacts and Prior Authorization

04.25.2006 Optometric and Eyeglass Services, April 2006: Covered Services Information for Initial/New Prescriptions for Eyeglasses

10.12.2005 Optometric and Eyeglass Services, October 2005: Covered Services Information for Initial/New Prescriptions

09.09.2005 Optometric and Eyeglass Services, August 2005: Eyeglass Service Modifiers, New Place of Service Codes

04.18.2005 Optometric and Eyeglass Services, April 2005: Clarification for Lens Add-Ons and Updated Key Contacts

01.19.2005 Optometric and Eyeglass Services, January 2005: Rule References Added

04.29.2004 Optometric and Eyeglass Services, April 2004: Updates for HIPAA, Covered Services, and Billing Procedures

07.09.2003 Optometric and Eyeglass Services, July 2003: Covered Services

Medicaid Rules and Regulations

Fee Schedules – Optician

Fee Schedules - Eyeglasses

PDF EXCEL
12/01/2016 December 2016 Eyeglasses Revised 12/15/2016 12/01/2016 December 2016 Eyeglasses Revised 12/15/2016

 

Provider Notices 2010–2016

2016

11/29/2016 Walman Optical Fram Warranty Procedure
10/14/2016 Eyeglass Contractor Change
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
01.13.2016 Requesting Prior Authorization from Medicaid or Healthy Montana Kids (HMK) for Certain Eyeglass Services

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

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 and Terminology Change Regarding Method of Payment

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

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

10.02.2012 New Optometric Codes Require Prior Authorization

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

11.22.2011 Reimbursement for Eyeglasses for Youth in an In-State Psychiatric Residential Treatment Facility

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

06.04.2010 Medicaid Consultation Services

05.25.2010 Medicaid Incentive Payment Program for Adopting Electronic Health Records

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

07.09.2009 Optical Services Paid by RBRVS

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

02.19.2008 New HCPCS.CPT Codes

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®

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

03.08.2007 New and Deleted Codes

2000–2006

02.10.2006 New and Deleted Codes

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

02.01.2005 New and Deleted Codes and New Botox Criteria

07.01.2004 Reminder: New Prescriptions for Eyeglasses

06.10.2004 Prescription Drug Prior Authorization Additions

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

02.25.2004 New Code for Minor Repairs

02.01.2004 New and Deleted Codes

01.01.2004 New and Discontinued Optometric Codes

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

01.27.2003 Optometric Program Update

01.10.2003 New Provider Notification Procedure and Medicaid Changes

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

02.14.2002 Weekly Payment Available

06.01.2001 Global Surgery Periods (Effective July 1, 2001)

03.20.2000 Global Surgery Periods (Effective May 1, 2000)

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.

Prior Authorization Information 08.2015

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.