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School-Based Services

School-Based Services

Provider Manuals

General Information for Providers 02/2017

Medicaid manual with general information for all provider types.

School-Based Services 07.2013

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
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

School-Based Services

07.10.2013 School-Based Services, May 2013: Entire Manual
These replacement pages includes a terminology change (client to member); however, unless a paragraphs also included content changes, it is not marked as a change.
04.27.2012 School-Based Services, April 2012: Covered Services
06.09.2011 School-Based Services, June 2011: Covered Services
09.16.2008 School-Based Services, April 2008: Key Contacts, Covered Services, Billing Procedures, and Claim Instructions
02.14.2007 School-Based Services, February 2007: Revised Physician Order Information, New Private Duty Nursing Request Form
04.25.2006 School-Based Services, April 2006: Coordination of Benefits Information
01.17.2006 School-Based Services, January 2006: Documentation Requirements, Restricted CSCT Services, Private-Duty Nursing Review Requirements, and School-Based Services Codes
10.06.2005 School-Based Services, August 2005: Covered Services and Billing Information for CSCT and Therapy
05.12.2005 School-Based Services, May 2005: Key Contacts and Place of Service
04.11.2005 School-Based Services, April 2005: Key Contacts
08.30.2004 School-Based Services, August 2004: Audiology Services Defined
04.26.2004 School-Based Services, April 2004: Key Contacts and Websites, Covered Services, COB, Billing Procedures, Claim Forms, RAs and Adjustments, Forms and Definitions
01.14.2004 School-Based Services, January 2004: Covered Services Error Correction
12.23.2003 School-Based Services, December 2003:CSCT Changes

Passport to Health

11.09.2015 Passport to Health, November 2015: Passport Referrals

Medicaid Rules and Regulations

Fee Schedules – School-Based Services

PDF Excel
01/2017 January 2017 Schools 01/2017 January 2017 Schools
10/2016 October 2016 Schools 10/2016 October 2016 Schools
07.2016 July 2016 Schools 07.2016 July 2016 Schools
09.17.2015 October 2015 Schools 09.17.2015 October 2015 Schools
07.2015 July 2015 Schools 07.2015 July 2015 Schools
10.2014 October 2014 Schools 10.2014 October 2014 Schools
07.2014 July 2014 Schools                                   07.2014 July 2014 Schools                                  
02.2014 January 2014 Schools      02.2014 January 2014 Schools     
12.2013 December 2013 Schools 12.2013 December 2013 Schools
07.2013 July 2013 Schools 10.2013 07.2013 July 2013 Schools 10.2013
01.2013 January 2013 Schools 01.2013 January 2013 Schools
09.2012 October 2012 Schools 09.2012 October 2012 Schools
07.2012 July 2012 Schools 07.2012 July 2012 Schools
09.2011 October 2011 Schools FY 2012 09.2011 October 2011 Schools FY 2012
07.2011 August 2011 Schools 07.2011 August 2011 Schools
04.2011 April 2011 Schools 08.02.2011 04.2011 April 2011 Schools 08.02.2011
01.2011 January 2011 Schools 08.02.2011 01.2011 January 2011 Schools 08.02.2011
07.2010 July 2010 Schools 08.02.2011 07.2010 July 2010 Schools 08.02.2011
10.2009 October 2009 Schools 02.2010 10.2009 October 2009 Schools 02.2010
07.2009 July 2009 Schools 08.24.2009 07.2009 July 2009 Schools 08.24.2009
04.2009 April 2009 Schools 08.24.2009 04.2009 April 2009 Schools 08.24.2009
10.2008 October 2008 Schools 05.05.2009 10.2008 October 2008 Schools 05.05.2009
07.2008 July 2008 Schools 07.29.2008 07.2008 July 2008 Schools 07.29.2008
10.2007 October 2007 Schools 10.2007 October 2007 Schools
10.2006 October 2006 Schools 10.2006 October 2006 Schools
07.2006 July 2006 Schools 07.2006 July 2006 Schools
01.2006 January 2006 Schools 01.2006 January 2006 Schools
10.2005 October 2005 Schools 10.2005 October 2005 Schools
07.2005 July 2005 Schools 07.2005 July 2005 Schools
01.2005 January 2005 Schools 01.2005 January 2005 Schools
07.2004 July 2004 Schools 07.2004 July 2004 Schools

Fee Schedules – 72-Hour Presumptive

Fee Schedules – Medicaid Mental Health

Fee Schedules – Mental Health Services Plan (MHSP)

Provider Notices 2010–

2017

01/03/2017 New Guidelines for Outpatient Psychotherapy
02/02/2017 EPSDT ( Children's) Lead Screening Requirements

 

2016

11/01/2016 ICD 10 Updates and Coding Changes Revised 12/07/2016

10/03/2016

FMAP Rate Reflect Change to Reimbursement on the Fee Schedule

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
11.02.2015 CSCT Claims Issues Related to Updated Severe Emotional Disturbance (SED) Definition
0.01.2015 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
10.06.2014 2015 FMAP Rate Reflects Changes to Reimbursement on the Fee Schedule
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
06.27.2014 Reimbursement Rate Changes and Terminology Change Regarding Method of Payment
06.12.2014 ICD-10 Delay
05.13.2014 PERM Provider Educational Webinars
05.05.2014 CSCT Requirement
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
09.27.2013 Changes to Prior Authorization Requirements for Therapeutic Youth Group Homes – Additional Information
09.24.2013 Changes to Contract with Magellan Medicaid Administration (MMA)
09.23.2013 New FMAP Rate Reflects Changes to Reimbursement on the Fee Schedule
09.11.2013 Electronic Funds Transfer (EFT) and Electronic Remittance Advice (ERA) Changes
09.10.2013 New Services for Orientation and Mobility (O&M) Specialists for Schools
09.03.2013 Changes to Contract with Magellan Medicaid Administration (MMA)
08.15.2013 New Comprehensive School and Community Treatment (CSCT) Requirement
07.10.2013 Psychiatrist Service Reimbursement Change and Timely Billing Requirement
07.08.2013 Montana Medicaid DSM-5 Implementation
05.28.2013 DPHHS to Discontinue Temporary Hotline Number
04.22.2013 Blanket Denials for Direct Care School Services No Longer Needed
02.19.2013 Montana Medicaid HIPAA Operating Rules Upgrade

2012

12.26.2012 Medicaid/HMK Plus Toll-Free Number
10.02.2012 New FMAP Rate Reflects Changes to Reimbursement on the Fee Schedule
08.22.2012 Deleted ICD-9-CM Codes
02.07.2012 Comprehensive School and Community Treatment (CSCT) Program Changes
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)

08.25.2011 CSCT Team Number on 5010 Electronic Claim (837P) Transactions (Effective 01.01.2012)

07.22.2011 School-Based Service Rate Changes

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

04.12.2011 Request: Claims Submission, Date of Payment by June 30, 2011

2010

11.17.2010 Free Care and CSCT

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 Resource-Based Relative Value Scale (RBRVS) Information

06.22.2010 Electronic Health Records Link

02.09.2010 United States 2010 Census

Provider Notices 2001–2009

2009

10.01.2009 Healthy Montana Kids Plan
05.07.2009 FMAP Adjustment for School-Based Services Including Comprehensive School and Community Treatment (CSCT) Program
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
07.24.2008 New FMAP Rate Reflects Changes to Reimbursement on the Fee Schedule
07.24.2008 Medicaid Administrative Claiming (MAC) Program Extended
07.10.2008 Multiple Conversion Factors for RBRVS Providers
07.08.2008 Adjustment for Claims Using Multiple Conversion Factors
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
03.03.2008 Passport Requirement Removed From School-Based Services 03.18.2008
03.03.2008 Place of Service Change for CSCT Services
02.14.2008 Elimination of Medicaid Administrative Claiming (MAC)
01.29.2008 Enhanced Claims Editing—Medicare Correct Coding Initiative Edits (CCI)
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
11.13.2007 New Rates
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®
09.17.2007 Montana Healthcare Schools Re-Enrollment and Billing CSCT 05.05.2008
08.01.2007 Elimination of eSOR
06.25.2007 NPI on the Web Portal
06.11.2007 Ownership and Control Information Required for Re-Enrollment
06.06.2007 NPI Contingency Plan Implemented, Re-Enrollment Extended
05.31.2007 New CMS-1500 to Be Required Beginning July 2, 2007
05.01.2007 Future FMAP Rate Reflects Changes to Reimbursement on the Fee Schedule
04.20.2007 Montana Healthcare Schools Reenrollment With Managing Employee Social Security Number and Date of Birth
02.23.2007 New FMAP Rate Reflects Changes to Reimbursement on the Fee Schedule
01.01.2007 Federal Medical Assistance Percentage (FMAP) Change

2000–2006

10.31.2006 New Permission to Bill Medicaid Form
07.28.2006 Third-Party Insurance Must Be Billed Prior to Billing Medicaid
08.31.2005 Federal Medical Assistance Percentage (FMAP) Change
07.28.2005 Scales – Congestive Heart Failure
04.04.2005 Pricing Logic Changes for Professional (CMS-1500) Claims
02.04.2005 Introduction to Preferred Drug List
08.31.2004 CSCT Services Audit and Program Requirements
07.29.2004 New Fee Schedule Reflects Reimbursement Changes
06.10.2004 Team Care Program A New Component of the Passport to Health Program
02.25.2004 Billing for CSCT Services
10.12.2003 CSCT Changes
10.01.2003 Manual Replacement Pages with Billing Correction
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
05.05.2003 CSCT Program Reinstated
04.14.2003 New Services Schools
01.10.2003 New Provider Notification Procedure and Medicaid Changes
01.10.2003 Therapy Service Limits
12.12.2001 School-Based Services Third Party Billing

Medicaid Administrative Claiming (MAC)

School Based ICD-10, Direct Care, and MAC 09.21.2015
This training applies to School Based service providers and the need to start coding ICD-10 diagnosis codes for October 1, 2015, dates of service forward. Refresher on Direct Care and MAC services are also included.
MAC Training (Coordination and Financial Officers) 03.2015
MAC Agreement Memorandum of Understanding 03.2015
This is the agreement that needs to be signed by the district representative and the state Medicaid Administrator in order for your district to participate in the Medicaid Administrative Claiming Program.
MAC Coordinators' Guide 03.2015
This guide provides a program overview for the person responsible for overseeing the implementation of the MAC program in the district or cooperative. It details how to prepare the participant listing, training time study participants, and managing the time study observation forms.
MAC Financial Data Guide 03.2015
This guide details the requirements for the financial data report necessary for submitting district expenditures in support of Medicaid services.
MAC Time Study Guide 03.2015
This guide provides time study participants information and guidelines on how to complete the Random Moment Sample Time Study Observation forms. It gives details and examples of the activity codes.
MAC Time Study Participant Training 03.2015
This presentation is designed to train the staff who will be participating in the RMS Time Study.

Participant Training Quiz 03.2015
This quiz can be used at the end of your training session to help participants code activities. It can be used individually or as a group discussion. This paper can also serve as your documentation of training to keep in your audit file.

Participant Training Quiz with Answers 03.2015

MAC Activity Code Reference Guide and Definitions 03.2015
This guide gives a detailed description of each activity code and provides examples of when the code should be used. Coordinators will find this useful when checking over the observation forms. This one-page definition of the activity codes should be copied onto the back of every Random Moment Observation form. It gives examples of when to use each activity code.
SURS Provider Self-Audit Protocol 10.2015