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Lab and Imaging

Lab and Imaging

Provider Manuals

General Information for Providers 02/2017

Medicaid manual with general information for all provider types.

Physician-Related Services 11/2016

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
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 2014: Team Care and Nurse First Information Added

Physician-Related Services

11/28/2016 In summary, the Page 5.6 of the Billing Procedures chapter was amended to add information for locum tenens, several links were updated, and two blank pages were removed. The Table of Contents and Index sections were adjusted, several links were updated in the Introduction and Covered Services Chapter, the entire manual was formatted as approved by the September 2016 Manuals Meeting for initial 508 adaptations, and the Cover page was amended with the current date.

09/12/2016 In summary, the entire manual has undergone formatting changes, the Billing Procedures section has had some minor language changes and the Cover reflects the current date.

08.31.2016 In summary, The cost share section was removed from the Billing Procedures Chapter, related entries were removed from the Index Section adjustments were made to the Index Section , and the date was changed on the Cover Page.

07.31.2015 Physician-Related Services, August 2015: Entire Manual

07.08.2014 Physician-Related Services, July 2014: Multiple Chapters

03.14.2008 Physician-Related Services, March 2008: Key Contacts, Completing a Claim Form, Prior Authorization, Billing for Immunizations

07.25.2006 Physician-Related Services, July 2006: Well-Child EPSDT Update

04.25.2006 Physician-Related Services, April 2006: Revised Instructions for Completing a Claim, Revised Information on How Cost-Sharing Affects Claim Payment

01.05.2006 Physician-Related Services, September 2005: New EPSDT, Hysterectomy Acknowledgement Form, Revised Information on Imaging Modifiers, Billing for Immunizations, and ER Visits for Clients under Age 2

03.01.2005 Physician-Related Services, March 2005: Hysterectomy Acknowledgement Update

01.25.2005 Physician-Related Services, January 2005: Rule References Added, Updates to Covered Services, PA and Modifiers

11.16.2004 Physician-Related Services, November 2004: Updated Prescription Drug PA Criteria

09.15.2004 Physician-Related Services, September 2004: Team Care Added

06.16.2004 Physician-Related Services, July 2004: Clarification on Sterilizations, Hysterectomies, Abortions and HIPAA and Drug PA Update

12.23.2003 Physician-Related Services, December 2003: Immunizations, PA Criteria, Family Planning, and Using Modifiers

09.16.2003 Physician-Related Services, September 2003: Hysterectomies and Prescription Drug PA Update

08.20.2003 Physician-Related Services, June 2003: New Emergency Services Policy and Hard Card Information

07.28.2003 Physician-Related Services, August 2003: Hysterectomy Requirements

06.01.2003 Physician-Related Services, June 2003: New PA Requirements and Hysterectomy Information

01.02.2003 Physician-Related Services, January 2003: Prior Authorization

09.01.2002 Physician-Related Services, September 2002: Cost Sharing

Medicaid Rules and Regulations

Fee Schedules – ATP Tests and Fees

01/17/2017  PDF January 2017 ATP  EXCEL January 2017 ATP
12/24/2015 January 2016 ATP  
01/2015 January 2015 ATP  
01/2014 January 2014 ATP      

Fee Schedules – Lab and Imaging

01/09/2017 PDF January 2017 Lab and Imaging Rev. 01/13/2017 Excel January 2017 Lab and Imaging Rev. 01/13/2017
07/2016  PDF July 2016 Lab and Imaging Rev. 08/22/2016 Excel July 2016 Lab and Imaging Rev. 08/22/2016
01/18/2016 PDF  January 2016 Lab and Imaging Rev. 01/22/2016 Excel January 2016 Lab and Imaging Rev. 01/22/2016
07/2015 PDF July 2015 Lab and Imaging Rev. 11/2015 Excel July 2015 Lab and Imaging Rev. 11/2015
01/2015 PDF January 2015 Lab and Imaging Rev. 02/2015 Excel January 2015 Lab and Imaging Rev. 02/2015
07/2014 PDF  July 2014 Lab and Imaging Rev. Excel July 2014 Lab and Imaging Rev.
02/2014 PDF January 2014 Lab and Imaging Rev. Excel January 2014 Lab and Imaging Rev.

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
01/13/2017 Update to January 2017 Fee Schedule
02/02/2017 EPSDT ( Children's) Lead Screening Requirements

 

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

06/22/2015 Identification of Ordering and Referring Providers on CMS-1500 and 837P X12 Transactions

06/09/2015 National Drug Code (NDC) Billing

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

04/22/2014 Modifier Changes for Professional Claim Billers

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 Servicees and How It Affects Other Montana Medicaid Providers

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.

Lab Panels 2007 01/2007
List of codes that make up lab panels for 2004–2007

Prior Authorization Criteria for Specific Services

Rebateable Manufacturers 04/2017

SURS Provider Self-Audit Protocol 10/2015

To locate older documents, access the Archive Page.