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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

 

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, 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

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
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.