Nursing Facility Nursing Facility Provider Manuals General Information for Providers 02/2017 Medicaid manual with general information for all provider type Nursing Facility and Swing Bed Services 10/2017 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 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 08.01.2015 General Information for Providers: Entire Manual 11.19.2014 General Information for Providers: Billing Procedures 10.08.2014 General Information for Providers: Billing Procedures 07.22.2014 General Information for Providers: Member Eligibility and Responsibilities 06.30.2014 General Information for Providers: 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 04.29.2005 General Information for Providers, April 2005: Client 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 Nursing Facility and Swing Bed Services 10/18/2016 Nursing Facility and Swing Bed Services The Manual has been edited and revised in its entirety. Please replace the entire manual. 03.05.2012 Nursing Facility and Swing Bed Services, March 2012: Notice of Transfer or Discharge 12.21.2011 Nursing Facility and Swing Bed Services: Key Contacts, Covered Services, Billing Procedures, Submitting a Claim, RA, Forms and Definitions 03.03.2011 Nursing Facility and Swing Bed Services, January 2011: Entire Manual 06.08.2010 Nursing Facility and Swing Bed Services: Appendix A, June 2010: Nurse Aide Certification and Training and Competency Evaluation (Testing) Survey Form 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 – Ancillary Services PDF Excel 01.2014 January 2014 Ancillary Services 01.2014 January 2014 Ancillary Services 09.2004 September 2004 Ancillary Services 09.2004 September 2004 Ancillary Services 03.2004 Ancillary Service Code Crosswalk 03.2004 Ancillary Service Code Crosswalk 03.2004 March 2004 Ancillary Services 03.2004 March 2004 Ancillary Services 01.2004 January 2004 Ancillary Services 01.2004 January 2004 Ancillary Services Provider Notices 2010– 2017 04/06/2017 New EPSDT Request Form 2016 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 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 06.24.2015 ICD-10 and Nursing Facility Requirements 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 06.12.2014 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 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 11.07.2011 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 06.22.2010 Electronic Health Records Link 02.09.2010 United States 2010 Census Provider Notices 2002–2009 2009 10.01.2009 Healthy Montana Kids Plan 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 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 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 2002–2006 07.28.2005 Scales – Congestive Heart Failure 02.04.2005 Introduction to Preferred Drug List 06.10.2004 Team Care Program A New Component of the Passport to Health Program 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 01.10.2003 New Provider Notification Procedure and Medicaid Changes 10.01.2002 Billing for Medicare Crossovers After Medicare's 45-Day Response Time 06.20.2002 Passport to Health 24-Hour Availability 02.14.2002 Weekly Payment Available On-line Staffing Report On-Line Staffing Report Resources On-line Report Page On-Line Staffing Report Letter Sample On-Line Staffing Report Form On-line Staffing Report Instructions General On-Line Staffing Report Information 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. 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.