Federally Qualified Health Center FQHC Federally Qualified Health Center Provider Manuals General Information for Providers 02/2017 Medicaid manual with general information for all provider types. Federally Qualified Health Center Services 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. 08.02.2016 The Introduction contains updated links in the HELP section. Cost Share was updated in the Billings Procedure. A duplicate word was removed in the RA chapter. The Cover Page was changed to reflect the current date of the new General Manual revision. 07.12.2016 General Information For Providers, July 2016 Table of Contents was amended by changing the title of “Basic Medicaid Waiver” to “Waiver for Additional Services and Populations (formerly Basic Medicaid Waiver)”. Index was amended by changing the title of “Basic Medicaid Waiver” to “Waiver for Additional Services and Populations (formerly Basic Medicaid Waiver)”. Page 1.3 changed the title “Basic Medicaid Waiver for Additional Services and Populations” to “Waiver for Additional Services and Populations (formerly Basic Medicaid Waiver)” 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, July 2014: Member Eligibility and Responsibilities 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 Federally Qualified Health Center Services 07.27.2016 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 FQHC, January 2016, HELP Plan-Related Updates and Others 08.25.2015 FQHC, August 2015:Changes in the Introduction, Covered Services, Prior Authorization, Billing Procedures, Submitting a Claim, and the How Payment Is Calculated 04.29.2015 FQHC, March 2015: Entire Manual 10.29.2013 FQHC, October 2013: Key Contacts, Covered Services, Billing Procedures, Submitting a Claim, RAs and Adjustments 07.05.2013 FQHC, June 2013: Other Programs These replacement pages include a terminology change (client to member). Unless a paragraphs included content changes, it was not marked as a change but was included in this document. 03.22.2013 FQHC, March 2013: Coordination of Benefits 07.20.2011 FQHC, June 2011 08.24.2007 FQHC, August 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 Code of Federal Regulations (Title 42) Montana Code Annotated (Title 53, Chapter 6) Administrative Rules of Montana (Title 37) Chapter 79 Healthy Montana Kids Chapter 82 Medicaid Eligibility Chapter 83 Medicaid for Certain Medicare Beneficiaries and Others Chapter 85 General Medicaid Services Chapter 86 Medicaid Primary Care Services Provider Notices 2010– For prescription medication notices, see the Pharmacy page. 2017 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 2016 11/14/2016 Licensed Addiction Counselors (LAC) added to the added to the definition of a Health Professional/core provider for Montana Medicaid FQHC 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 2015 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 2014 12.18.2014 Electronic Funds Transfer (EFT) and Electronic Remittance Advice (ERA) Changes Final Update 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 2013 12.23.2013 Electronic Funds Transfer (EFT) and Electronic Remittance Advice (ERA) Changes Update 11.26.2013 ICD-10 Readiness 11.07.2013 Medicaid Passport to Health Referrals and Fee Schedules 11.07.2013 Radiology Procedures and Medicaid Passport to Health Referrals 11.07.2013 Podiatrists and Medicaid Passport to Health Referrals 09.27.2013 Healthy Montana Kids (HMK) Vaccination Billing Changes 09.27.2013 Changes to Prior Authorization Requirements for Therapeutic Youth Group Homes – Additional Information 09.11.2013 Electronic Funds Transfer (EFT) and Electronic Remittance Advice (ERA) Changes 07.10.2013 Psychiatrist Service Reimbursement Change and Timely Billing Requirement 07.05.2013 Medicaid/HMK Plus and Sports Physicals 06.20.2013 Montana Plan First – Additional Information 05.28.2013 DPHHS to Discontinue Temporary Hotline Number 05.13.2013 Montana Plan First – Revised List of Plan First Covered Services 05.06.2013 Passport to Health Disenrollment Requirements for Providers Disenrolling a Member 05.06.2013 Pneumococcal Influenza Vaccination/Administration and Contraceptive Injections Not Separately Billable 02.19.2013 Montana Medicaid HIPAA Operating Rules Upgrade 02.12.2013 BRCA1 and BRCA2 Testing Update 02.11.2013 Montana Plan First Additional Information Updated 2012 12.26.2012 Medicaid/HMK Plus Toll-Free Number 12.24.2012 BRCA1 and BRCA2 Testing 12.17.2012 American Medical Association Adopts New Psychiatric Diagnostic and Psychological Codes 12.04.2012 Payment Rate Increases for Calendar Year 2013 Effective 01.01.2013 10.01.2012 Concurrent Outpatient Mental Health Therapy Services Reimbursed by Children’s Medicaid 08.22.2012 Deleted ICD-9-CM Codes 06.11.2012 Plan First Effective 06.01.2012 03.02.2012 Rate Change for RHCs and FQHCs 02.13.2012 Emergency Room Services Update 01.06.2012 Smoking and Tobacco Use Cessation Counselor Services 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 11.04.2011 Meeting the Requirements of HIPAA 5010 When Reporting National Drug Codes on Electronic 837I and 837P Transactions 11.16.2011 10.07.2011 Influenza Virus Vaccine 09.09.2011 HIPAA 5010.OCR Qualifier Changes Effective January 1, 2012 09.09.2011 DME Order and Prescription Requirements 09.07.2011 Payment Error Rate Measurement (PERM) 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 06.24.2011 PRTF Waiver Site Denial Required 05.05.2011 Renew Passport Provider Agreement 04.12.2011 Request: Claims Submission, Date of Payment by June 30, 2011 03.23.2011 Changes to Procedure Code Indicators 02.07.2011 Vaccine Administration Code Update 2010 10.05.2010 Changes to NCCI Edits 09.15.2010 Unlinking Passport Providers No Longer Part of Group Practice 07.29.2010 Rural Health Clinic Billing Reminder 07.28.2010 Provider Record Update Procedures 07.15.2010 Vaccine Update Effective February 23, 2010 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 06.04.2010 Medicaid Consultation Services 05.28.2010 Clinical Laboratory Fee Schedule (CLFS) Instructions for Test Codes 80100, 80101, 80101 QW, G0430, G0430 QW, and G0431 QW 02.09.2010 United States 2010 Census 02.08.2010 Medicaid Health Improvement Program 02.03.2010 Medicaid Consultation Services 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 03.16.2009 Timely Filing for Medicare Crossovers 02.25.2009 Vaccines for Children (VFC) Effective as of October 10, 2008 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 07.11.2008 Changes in Mental Health Services Plan for Adults Age 18 and Older 05.22.2008 Frequently Asked Questions About NPI Reenrollment and Billing 06.17.2008 05.01.2008 RHC.FQHC Taxonomy on Provider Encounters in Hospitals 03.10.2008 NPI Reenrollment and Billing 02.19.2008 New HCPCS.CPT Codes 02.13.2008 Tamper-Resistant Prescription Pads 01.28.2008 Expansion of Provider Types for the Mental Health Services Plan 01.18.2008 Possible Duplicate Claims Processed Through Electronic Data Interchange 01.11.2008 Vaccines for Children (VFC) 2007 12.28.2007 New Codes for Smoking and Tobacco Use Cessation Counseling 12.27.2007 2008 FQHC and RHC Rate Increase 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® 10.31.2007 RHC Services in Hospitals 10.03.2007 VFC Update 10.01.2007 Attending Provider 10.01.2007 Tamper-Resistant Prescription Pads – Postponed 09.28.2007 Smoking and Tobacco Use Cessation Counseling 09.20.2007 Tamper-Resistant Prescription Pads – Updated 08.27.2007 Vaccines for Medicare Part D Participants 08.07.2007 Tamper-Resistant Prescription Pad Requirement 08.01.2007 Elimination of eSOR 07.06.2007 Coverage of 17 Alpha-Hydroxyprogesterone Caproate 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 04.16.2007 VFC Update Updated from 01.24.2007 04.16.2007 Coverage of HPV Vaccine 03.08.2007 New and Deleted Codes 01.18.2007 Admit Hour to Be Required for Institutional Claims 2006 09.22.2006 VFC Update 06.30.2006 Revenue Code Changes Effective July 1 04.18.2006 VFC Update 03.01.2006 VFC Update 02.24.2006 Passport Required for FQHCs, RHCs and Home Health 02.10.2006 New and Deleted Codes 01.05.2006 Increased Reimbursement for EPSDT Preventive Services 2005 07.28.2005 Scales – Congestive Heart Failure 07.01.2005 Revised Processing for Emergency Room Visits 07.01.2005 VFC Update 06.01.2005 Medicaid Coverage Update 03.01.2005 Hysterectomy Acknowledgement Update 02.04.2005 Introduction to Preferred Drug List 02.01.2005 New and Deleted Codes and New Botox Criteria 2004 06.10.2004 Prescription Drug Prior Authorization Additions 06.10.2004 Team Care Program A New Component of the Passport to Health Program 02.01.2004 New and Deleted Codes 01.01.2004 VFC Changes Updated from 12.2003 2003 10.17.2003 Q & A Regarding Reporting ICD-9-CM Procedure Codes 10.14.2003 Form Locator Update 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 07.31.2003 Passport and Emergency Services 07.28.2003 Hysterectomy Requirements 03.01.2003 Pharmacy Prior Authorization and Refill Changes 02.03.2003 New Billing Requirements for UB-92 Billers 01.29.2003 Prescription Drug Services Update 01.15.2003 Dental Program Changes 01.10.2003 New Provider Notification Procedure and Medicaid Changes 01.02.2003 Drug Prior Authorization Update 2001–2002 10.07.2002 Presumptive Eligibility 10.01.2002 Billing for Medicare Crossovers After Medicare's 45-Day Response Time 09.01.2002 Cost Sharing 07.01.2002 2.6% Reduction 06.20.2002 Passport to Health 24-Hour Availability 03.21.2002 Prior Authorization Reminders: DME, DMEPOS 02.22.2002 Payment Methodology Change Updated 04.21.2006 02.14.2002 Weekly Payment Available 05.29.2001 Billing for Lab Panels 05.09.2001 Billing for Abortion Service 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 MHSP Clinical Eligibility Assessment Form 07.2009 MHSP Covered SDMI Diagnoses 07.2009 Plan First Medicaid Non-Covered Agreement 07.2012 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 email@example.com. Thank you.