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Indian Health Service (IHS)

IHS

Indian Health Service

Provider Manuals

General Information for Providers 02/2017

Medicaid manual with general information for all provider types.

Indian Health Service/Tribal 638 08.2016

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, May 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

Indian Health Service/Tribal 638

08.08/2016 Indian Health Service, August 2016:

In Summary, the Cost Share section of the Billing Procedure Chapter was removed and replaced with a referral to the Cost Share section of the General Manual. The Cover Page was changed to reflect the current manual edition date.

 

07.01.2015 Indian Health Service, July 2015: Entire Manual
08.01.2014 Indian Health Service, June 2014: Billing Procedures
04.04.2014 Indian Health Service, February 2014: Multiple Chapters
08.29.2013 Indian Health Service, July 2013: Key Contacts and Billing Procedures
05.15.2013 Indian Health Service, April 2013: Entire Manual
This set of replacement pages includes the entire IHS manual. Content changes are indicated by the addition of a change bar (black line). Text in tables and paragraphs in which text was deleted are not indicated with change bars. For a complete manual without the change bars, see the Provider Manuals section at the top of this page.

Passport to Health

11.09.2015 Passport to Health, November 2015: Passport Referrals

 

   
   
   
   

Medicaid Rules and Regulations

Fee Schedules – IHS

Provider Notices 2010–

2017

04/20/2017  Plan First Hysterectomy codes added effective April 1, 2017
04/06/2017 New EPSDT Request Form
02/02/2017 EPSDT ( Children's) Lead Screening Requirements

2016

12/21/2016 Substance Use Disorder Billing
07.28.2016 Montana Plan First Preventive Code Additions
07.25.2016 Admission Date and Statement Covers Period - Revised
07.18.2016 Changes to Member Cost Share Update
07.01.2016 Admission Date and Statement Covers Period
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
10.01.2015 Changes to the Children's Mental Health Bureau Medicaid Services Provider Manual
09.08.2015 Billing Montana Medicaid for Durable Medical Equipment (DME) Diabetic Supplies
08.28.2015 Substance Use Disorder, Revenue Code 944
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
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 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 and 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
06.22.2010 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 2003–2009

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

05.22.2008 Frequently Asked Questions About NPI Reenrollment and Billing 06.17.2008

03.10.2008 NPI Reenrollment and Billing

02.20.2008 Changes to Prior Authorization for Circumcision 08.05.2008

02.19.2008 New HCPCS.CPT Codes

02.13.2008 Tamper-Resistant Prescription Pads

01.18.2008 Possible Duplicate Claims Processed Through Electronic Data Interchange

01.11.2008 Vaccines for Children (VFC)

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

11.01.2007 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®

10.16.2007 Smoking and Tobacco Use Cessation Counseling

10.03.2007 VFC Update

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

04.18.2006 VFC Update

03.01.2006 VFC Update

02.10.2006 New and Deleted Codes

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

06.01.2004 Important Reminder Regarding Sterilizations, Hysterectomies and Abortions

02.01.2004 New and Deleted Codes

01.01.2004 VFC Changes Updated from 12.2003

2003

12.01.2003 VFC Changes

12.01.2003 Discontinued Local Codes

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

06.01.2003 Discontinued Services That Now Require Prior Authorization

02.03.2003 New Billing Requirements for UB-92 Billers

01.10.2003 New Provider Notification Procedure and Medicaid Changes

Tribal and Indian Health Service

Montana Medicaid strives to improve billing capacity within Tribal and Indian Health Service clinics. DPHHS is committed to improving the health of the Indian population in Montana.

For Tribal or Indian Health Service billing questions contact:
Casey Peck, IHS Program Officer, 406.444.4349 or CPeck@.gov
 

Tribal/IHS Meeting Information

Agenda Minutes Handouts/Information
Agenda March 28, 2017   Medicaid Refresher
Agenda February 28, 2017   Telemedicine PowerPoint Slides in PDF
Medicare Savings Plan (MSP) Powerpoint Slides in PDF
Agenda November 22, 2016   Durable Medical Equipment (DME) PowerPoint Slides in PDF
Agenda October 25, 2016   Optometry Presentation PowerPoint Slides in PDF

Agenda September 20, 2016

Minutes/Video of Meeting/Passport Presentation (in mp4)

 

Passport Presentation PowerPoint Slides in PDF

 

Agenda 08.23.2016

Minutes/Video of Meeting

 

Medicaid Transportation Program

Agenda 06.28.2016   HMK Overview

Agenda 05.24.2016

Minutes/Video of Meeting

Member Enrollment Tutorial

Agenda 04.26.2016   IHS Provider Enrollment Tutorial
  Minutes 11.20.2013  
Agenda 09.18.2013 Minutes 09.18.2013  
Agenda 08.21.2013 Minutes 08.21.2013  
Agenda 07.17.2013 Minutes 07.17.2013 Billing Multiple Visits
Agenda 06.19.2013 Minutes 06.19.2013  
Agenda 05.15.2013 Minutes 05.15.2013  
Agenda 04.17.2013 Minutes 04.17.2013  
Agenda 03.20.2013 Minutes 03.20.2013  
Agenda 02.20.2013 Minutes 02.20.2013 Claim Procedures HMK/CHIP Dental
  Minutes 01.16.2013  

Urban Indian Clinic Meeting Information

Agenda Minutes
Agenda 05.01.2013 Minutes 05.01.2013
Agenda 06.05.2013  

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
Prior Authorization Criteria for Specific Services
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.