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Rural Health Clinic


Rural Health Clinic

Provider Manuals

General Information for Providers 02/2017

Medicaid manual with general information for all provider types.

Rural Health Clinic 07/2016

This manual has information specific to your provider type.

Prescription Drug Program, Prior Authorization Chapter 01/2016

Prior authorization requirements and procedures are covered in this chapter.

Passport to Health 11/2015

Everything a provider needs to know to become a successful Passport provider.

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.





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, October 2014: Billing Procedures
07.22.2014 General Information for Providers, July 2014: Member Eligibility and Responsibilities
06.30.2014 General Information for Providers, June 2014
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

 Rural Health Clinic


RHC_FQHC Manual, July 2016.

In summary. the Cost share section was updated in the Billing Procedures chapter and the Cover Page was updated to reflect the correct date.



12.31.2015 RHC Manual, January 2016: HELP Plan-Related Updates and Others
08.25.2015 RHC Manual
Changes in the Introduction, Covered Services, Prior Authorization, Billing Procedures, Submitting a Claim, and the How Payment Is Calculated chapters.
04.29.2015 RHC Manual
10.29.2013 RHC, Key Contacts, Covered Services, Billing Procedures, Submitting a Claim, RAs and Adjustments
07.05.2013 RHC, Other Programs
These replacement pages also includes a terminology change (client to member). Unless a paragraphs also included content changes, it is not marked as a change but is included in this document.
03.22.2013 Coordination of Benefits
07.20.2011 RHC Services (Entire Manual)
08.24.2007 Key Contacts, Prior Authorization, Coordination of Benefits, and Revised Revenue Codes

Passport to Health

11.09.2015 Passport to Health, November 2015: Passport Referrals

Medicaid Rules and Regulations

Provider Notices

For prescription medication notices, see the Pharmacy page/


05/26/2017 Federal Final Rule, "Nondiscrimination in Health Program and Activities” and Implication for Coverage of Services Related to Gender Transition
05/01/2017 Vaccine Administration Code Update
04/20/2017  Plan First Hysterectomy codes added effective April 1, 2017
04/06/2017 New EPSDT Request Form
02/22/2017 Licensed Addiction Counselors added to definition of a health professional/core provider for FQHC and RHC
02/02/2017 EPSDT ( Children's) Lead Screening Requirements


11/14/2016 Licensed Addiction Counselors (LAC) added to the added to thedefinition of a Health Professional/core provider for Montana MedicaidFQHC and RHC facilities/
11/10/2016 Vaccines For Children Administration Update
07/28/2016 Montana Plan First Preventive Code Additions
07/18/2016 Changes to Member Cost Share Update
07/12/2016 Vaccine Administration Code Update
07/05/2016 PA For Botox No Longer Required
07/05/2016 Circumcision Prior Authorization Changes
05/19/2016 Changes to Member Cost Share
04/07/2016 Montana Plan First - IUD and Anesthesia Updates
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


12/31/2015 Changes to Montana Medicaid
11/03/2015 Services Exempt from Passport to Health Referral
10/09/2015 Montana Plan First – ICD-10 Update
10/01/2015 Changes to the Children's Mental Health Bureau Medicaid Services Provider Manual
08/19/2015 Identification of Ordering and Referring Providers on UB-04 and 837I X12 Transactions
08/17/2015 Medicare Crossover Claims With Medicare Non-Covered Charges That Medicaid Allows
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
07/08/2015 Montana Plan First – Revised List of Plan First Covered Services
06/26/2015 Vaccine Administrative Code Update
02/11/2015 New HCPCS Modifiers – XE, XP, XS, and XU
01/30/2015  Telehealth Diagnosis Codes


12/18/2014 Electronic Funds Transfer (EFT) and Electronic Remittance Advice (ERA) Changes Final Notice
11/25/2014 Telehealth
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
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. Forms

SURS Provider Self-Audit Protocol 10/2015  

To locate older documents, access the Archive Page.