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Montana Healthcare Programs Provider Information » Home and Community-Based Services

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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

PDF Excel
07.2016 July 2016 Elderly and Physically Disabled Waiver 07.2016 July 2016 Elderly and Physically Disabled Waiver
07.2015 July 2015 Elderly and Physically Disabled Waiver 07.2015 July 2015 Elderly and Physically Disabled Waiver
07.2014 July 2014 Elderly and Physically Disabled Waiver 07.2014 July 2014 Elderly and Physically Disabled Waiver
07.2013 July 2013 Elderly and Physically Disabled Waiver 07.2013 July 2013 Elderly and Physically Disabled Waiver
08.2011 September 2011 Elderly and Physically Disabled Waiver 08.2011 September 2011 Elderly and Physically Disabled Waiver
02.2011 March 2011 Elderly and Physically Disabled Waiver 02.2011 March 2011 Elderly and Physically Disabled Waiver
07.2010 July 2010 Elderly and Physically Disabled Waiver 07.2010 July 2010 Elderly and Physically Disabled Waiver
10.2009 October 2009 Elderly and Physically Disabled Waiver 10.21.2009 10.2009 October 2009 Elderly and Physically Disabled Waiver 10.21.2009
07.2009 July 2009 Elderly and Physically Disabled Waiver 07.01.2009 07.2009 July 2009 Elderly and Physically Disabled Waiver 07.01.2009
10.2008 October 2008 Elderly and Physically Disabled Waiver 09.29.2008 10.2008 October 2008 Elderly and Physically Disabled Waiver 09.29.2008
08.2008 August 2008 Elderly and Physically Disabled Waiver 08.2008 August 2008 Elderly and Physically Disabled Waiver
07.2008 July 2008 Elderly and Physically Disabled Waiver 07.23.2008 07.2008 July 2008 Elderly and Physically Disabled Waiver 07.23.2008
01.2008 January 2008 Elderly and Physically Disabled Waiver 01.2008 January 2008 Elderly and Physically Disabled Waiver
10.2007 October 2007 Elderly and Physically Disabled Waiver 10.2007 October 2007 Elderly and Physically Disabled Waiver
07.2007 August 2007 Elderly and Physically Disabled Waiver 08.08.2007 07.2007 August 2007 Elderly and Physically Disabled Waiver 08.08.2007
01.2007 January 2007 Elderly and Physically Disabled Waiver 05.21.2007 01.2007 January 2007 Elderly and Physically Disabled Waiver 05.21.2007

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

Fee Schedules – Psychiatric Residential Treatment Facility (PRTF) Waiver

PDF
07.2009 August 2009 PRTF Waiver 11.05.2009
09.2008 February 2008 PRTF Waiver

Provider Notices 2010–2016

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

2013

12.23.2013 Electronic Funds Transfer (EFT) and Electronic Remittance Advice (ERA) Changes Update

11.26.2013 ICD-10 Readiness

10.03.2013 1915(i) HCBS State Plan Amendment

09.11.2013 Electronic Funds Transfer (EFT) and Electronic Remittance Advice (ERA) Changes

09.09.2013 Montana CANS System (MCS) Electronic Database

06.28.2013 PRTF Montana CANS Implementation

05.28.2013 DPHHS to Discontinue Temporary Hotline Number

02.19.2013 Montana Medicaid HIPAA Operating Rules Upgrade

01.14.2013 New Program, Montana i-home, State Plan Amendment for Youth with Serious Emotional Disturbance (SED) and Fee Schedule

Montana i-home Referral Form

2012

12.26.2012 Medicaid/HMK Plus Toll-Free Number

10.09.2012 1915(c) HCBS Bridge Waiver for Youth with Serious Emotion Disturbance (SED)

10.09.2012 Bridge Waiver Codes, Modifiers, and Fees as of October 1, 2012

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)

08.22.2011 Elderly and Physically Disabled Waiver

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

06.29.2010 Home- and Community-Based Services for the Elderly and Physically Disabled Waiver Rate Increase Assisted Living

06.23.2010 Cost Sharing Exemption Under ARRA

06.23.2010 Changes to the First Health Services Provider Manuals, Clinical Guidelines and Forms Used for Utilization Management of Children's Mental Health Medicaid Services

06.22.2010 Electronic Health Records Link

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 2001–2009

2009

10.21.2009 Fee Schedule Changes

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 Mileage Reimbursement Increase

09.05.2008 Psychiatric Residential Treatment Facility Waiver

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

05.06.2008 New Rules for Case Management

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

02.04.2005 Introduction to Preferred Drug List

10.11.2005 Wheelchair CMNs – Transition Instructions

08.01.2005 Rate Increase

07.28.2005 Scales – Congestive Heart Failure

07.01.2005 Notice Regarding Rate Increase

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

07.01.2002 2.6% Reduction

03.21.2002 Prior Authorization Reminders: DME, DMEPOS

02.14.2002 Weekly Payment Available

07.03.2001 Provision of Nutrition or Medication by Gastronomy or Jejunostomy

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

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.