Department of Public Health and Human Services

Montana Healthcare Programs Provider Information » Psychiatric Residential Treatment Facility (PRTF)

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Psychiatric Residential Treatment Facility (PRTF)

PRTF

Psychiatric Residential Treatment Facility

Provider Manuals

General Information for Providers 02/2017

Medicaid manual with general information for all provider types.

Mental Health Services – Adult 03/2017

This manual has information specific to your provider type.

Mental Health Services – Children 10.2015

See the CMHB section of the Plans and Publications page on the DPHHS website.

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

Mental Health - Adult

2017

03/16/2017 In summary, some minor changes were made to language on the code chart on page 10.

08.25.2016 In Summary, the Cost Share section on pages 4 and 5 was removed and replaced with a referral to the general manual, and the index was adjusted to reflect impacted page numbers.

06.08.2016

Mental Health - Adult July 2016

In summary, the Cover Page date was changed and the Index was amended to replace  “Basic” and “Full” Medicaid to “Standard Medicaid”

Passport to Health

  11.09.2015   Passport to Health, November 2015: Passport Referrals

Medicaid Rules and Regulations

Fee Schedules – 72-Hour Presumptive

Fee Schedules – Medicaid Mental Health

Fee Schedules – Mental Health Services Plan (MHSP)

Provider Notices 2010–

2017

04/06/2017 New EPSDT Request Form
03/07/2017 PAs for Out of State Psychiatric Hospitals, Youth
1/03/2017 New Guidelines for Outpatient Psychotherapy

2016

11/01/2016 ICD 10 Updates and Coding Changes Revised 12/07/2016
07.18.2016 Changes to Member Cost Share Update
05.19.2016 Changes to Member Cost Share
05.10.2016 PRTF Ancillary Services
04.22.2016 Changes to PRTF Continued Stay Reviews
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
12.30.2015 Addictive and Mental Disorders Division Changes to Prior Authorization
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
09.17.2014 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

2013

12.23.2013 Reimbursement Changes for Covered Ancillary Services Provided to Youth in a PRTF and Additional Information Pertaining to PRTF Services
12.23.2013 Electronic Funds Transfer (EFT) and Electronic Remittance Advice (ERA) Changes Update
11.26.2013 ICD-10 Readiness
09.27.2013 Changes to Prior Authorization Requirements for Therapeutic Youth Group Homes – Additional Information
09.24.2013 Changes to Contract with Magellan Medicaid Administration (MMA)
09.11.2013 Electronic Funds Transfer (EFT) and Electronic Remittance Advice (ERA) Changes
09.09.2013 Montana CANS System (MCS) Electronic Database
09.03.2013 Changes to Contract with Magellan Medicaid Administration (MMA)
07.10.2013 Psychiatrist Service Reimbursement Change and Timely Billing Requirement
07.08.2013 Montana Medicaid DSM-5 Implementation
06.28.2013 PRTF Montana CANS Implementation
05.31.2013 Children's Mental Health Services Plan (CMHSP) Rules Repealed
05.28.2013 DPHHS to Discontinue Temporary Hotline Number
04.02.2013 Important PRTF Reminders
02.20.2013 Important PRTF Requirements
02.19.2013 Montana Medicaid HIPAA Operating Rules Upgrade

2012

12.26.2012 Medicaid/HMK Plus Toll-Free Number
12.26.2012 Secure Department-Approved Data Management System Developed Effective 10.26.2012
10.24.2012 Mental Health Center Severe Disabling Mental Illness (SDMI) Clinical Assessment is a Covered Ancillary Service for Youth in a PRTF
10.22.2012 Changes to the Children's Mental Health Bureau's Provider Manual and Clinical Guidelines for Utilization Management and Authorization Request Forms
 09.26.2012 Changes to the Interstate Compact on the Placement of Children (ICPC) Required  
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)
08.16.2011 Care Coordination Is Available on a Limited Basis for Youth in a Psychiatric Residential Treatment Facility
07.18.2011 Reimbursement Changes for Covered Ancillary Services Provided to Youth in a PRTF and Additional Ancillary Services Are Covered
07.18.2011 Prior Authorization Requirements Discontinued for Targeted Case Management (TCM) and Outpatient Therapy Concurrent with Comprehensive School Community Treatment (CSCT)
06.27.2011 HIPAA 5010.OCR Qualifier Changes Effective January 1, 2012
06.24.2011 PRTF Waiver Site Denial Required
04.12.2011 Request: Claims Submission, Date of Payment by June 30, 2011
03.29.2011 Interstate Compact on the Placement of Children Required

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 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

10.01.2009 Healthy Montana Kids Plan
04.10.2009 PRTF Three-Day Medication Supply
04.09.2009 Second Document of Frequently Asked Questions About Targeted Case Management (TCM) in Psychiatric Residential Treatment Facilities (PRTFs)
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
02.12.2009 Allowable Expenses for Targeted Case Management (TCM) Services in a Psychiatric Residential Treatment Facility (PRTF)
02.03.2009 Frequently Asked Questions on Targeted Case Management (TCM) Options for Psychiatric Residential Treatment Facilities (PRTFs) Starting March 1, 2009
01.27.2009 Montana Medicaid Reimbursement Change for Psychiatric Residential Treatment Facilities (PRTFs) for Both In- and Out-of-State Providers

2008

10.20.2008 Changes in Transplant Coverage Rev. 10.27.2008
08.12.2008 Federal Government May Request Medical Records Rev. 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 Rev. 06.17.2008
03.17.2008 Resubmission of Denied Claims Rev. 03.19.2008
03.10.2008 NPI Reenrollment and Billing
01.23.2008 Mental Health Fee Schedules 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
07.01.2003 Mental Health Program Changes and Fees 
07.01.2003 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
02.14.2002 Weekly Payment Available
02.23.2001 MHSP Coverage for Children
01.26.2001 New Definitions for SED and SDMI

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 mttpl@xerox.com. Thank you.