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Home and Community-Based Services

Home and Community-Based Services

Provider Manuals

General Information for Providers 02/2017

Medicaid manual with general information for all provider types.

Bridge Waiver for Youth with SED 07/01/2014

Policy manual for youth with Serious Emotional Disturbance (SED)

1915(i) HCBS State Plan Program for Youth with SED 07/01/2014

Policy manual for youth with Serious Emotional Disturbance (SED)

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

 

Bridge Waiver

Bridge Waiver for Youth with SED 07.01.2013

Bridge Waiver for Youth with SED 10.01.2012

1915(i)

1915(i) HCBS State Plan Program for Youth with SED 12.13.2013

1915(i) HCBS State Plan Program for Youth with SED 07.01.2013

1915(i) HCBS State Plan Program for Youth with SED 01.01.2013

Medicaid Rules and Regulations

Fee Schedules – 1915(i)

1915(i) was formerly Montana i-home.

Fee Schedules – Bridge Waiver

Fee Schedules – Elderly and Physically Disabled Waiver

Fee Schedules – HCBS for Adults with Severe Disabling Mental Illness (SDMI)

Fee Schedules – Psychiatric Residential Treatment Facility (PRTF) Waiver

07/2009 August 2009 PRTF Waiver Rev. 11.05.2009
 

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

07.18.2016 Changes to Member Cost Share Update
05.19.2016 Changes to Member Cost Share
02.16.2016 Changes to Rule 37.86.3503 Case Management Service for Adults with SMDI
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

09.03.2015 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

09.17.2014 Montana Child and Adolescent Needs and Strengths (CANS)

09.16.2014 Adoption of the New Children's Mental Health Bureau's Medicaid Provider Manual into Administrative Rules of Montana

08.13.2014 Community-Based Psychiatric Rehabilitation and Support (CBPRS) Clarification

08.13.2014 Montana Child and Adolescent Needs and Strengths (CANS)

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

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 Criteria for Specific Services

SURS Provider Self-Audit Protocol 10/2015

 

To locate older documents, access the Archive Page.