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Public Health Clinic

Public Health Clinic

Provider Manuals

General Information for Providers 02/2017

Medicaid manual with general information for all provider types.

Physician-Related Services 11/2016

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
11.172015 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, 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

Physician-Related Services

11/28/2016 In summary, the Page 5.6 of the Billing Procedures chapter was amended to add information for locum tenens, several links were updated, and two blank pages were removed. The Table of Contents and Index sections were adjusted, several links were updated in the Introduction and Covered Services Chapter, the entire manual was formatted as approved by the September 2016 Manuals Meeting for initial 508 adaptations, and the Cover page was amended with the current date.
09/12/2016 In summary, the entire manual has undergone formatting changes, the Billing Procedures section has had some minor language changes and the Cover reflects the current date.
08.31.2016 In summary, The cost share section was removed from the Billing Procedures Chapter, related entries were removed from the Index Section adjustments were made to the Index Section , and the date was changed on the Cover Page.
07.31.2015 Physician-Related Services, August 2015: Entire Manual, Removed EPSDT Well-Child
07.08.2014 Physician-Related Services, July 2014: Multiple Chapters
07.14.2008 Physician-Related Services, March 2008: Key Contacts, Completing a Claim Form, Prior Authorization, Billing for Immunizations
07.25.2006 Physician-Related Services, July 2006: Well-Child EPSDT Update
04.25.2006 Physician-Related Services, April 2006: Revised Instructions for Completing a Claim, Revised Information on How Cost-Sharing Affects Claim Payment
01.05.2006 Physician-Related Services, September 2005: New EPSDT, Hysterectomy Acknowledgement Form, Revised Information on Imaging Modifiers, Billing for Immunizations, and ER Visits for Clients Under Age 2
03.01.2005 Physician-Related Services, March 2005: Hysterectomy Acknowledgement Update
01.25.2005 Physician-Related Services, January 2005: Rule References Added, Updates to Covered Services, PA and Modifiers
11.16.2004 Physician-Related Services, November 2004: Updated Prescription Drug PA Criteria
09.15.2004 Physician-Related Services, September 2004: Team Care Added
06.16.2004 Physician-Related Services, July 2004: Clarification on Sterilizations, Hysterectomies, Abortions and HIPAA and Drug PA Update
12.23.2003 Physician-Related Services, December 2003: Immunizations, PA Criteria, Family Planning, and Using Modifiers
09.16.2003 Physician-Related Services, September 2003: Hysterectomies and Prescription Drug PA Update
08.20.2003 Physician-Related Services, June 2003: New Emergency Services Policy and Hard Card Information
07.28.2003 Physician-Related Services, Hysterectomy Requirements
06.01.2003 Physician-Related Services, New PA Requirements and Hysterectomy Information
01.02.2003 Physician-Related Services, January 2003: Prior Authorization
09.01.2002 Physician-Related Services, September 2002: Cost Sharing

Prescription Drug Program

12.31.2015 Prescription Drug Program, January 2016: HELP Plan-Related Updates and Others
09.27.2013 Reimbursement
09.05.2013 Entire Manual Including the New Passport Chapter
This set of replacement pages contains a terminology change ("client" to "member"); however, only content changes are marked with a change bar (black line).
04.17.2013 Key Contacts and Reimbursement
02.04.2013 Medicaid Covered Products
02.01.2012 Multiple Chapters
09.01.2011 Medicaid Covered Services and Reimbursement (Dispensing Fee) and MHSP Covered Products (Formulary Drugs)
06.17.2011 Prescription Drug Services
Entire manual has changed from last posted version.
11.16.2004 Updated Prescription Drug PA Criteria
06.16.2004 PA and HIPAA Updates
06.10.2004 Prescription Drug Prior Authorization Additions

Passport to Health

11.09.2015 Passport to Health, November 2015: Passport Referrals
 

Medicaid Rules and Regulations

Fee Schedules – Public Health

PDF Excel
01/09/2017 January 2017 Public Health 01/09/2017 January 2017 Public Health
07.13.2016 July 2016 Public Health Clinic Rev 08.22.2016 07.13.2016 July 2016 Public Health Clinic Rev 08.22.2016
01.18.2016 January 2016 Public Health Clinic 01.18.2016 January 2016 Public Health Clinic
08.04.2015 July 2015 Public Health Clinic Rev. 08.04.2015 July 20151 Public Health Clinic Rev.
01.2015 January 2015 Public Health Clinic 01.2015 January 2015 Public Health Clinic
07.2014 July 2014 Public Health Clinic 07.2014 July 2014 Public Health Clinic
02.2014 January 2014 Public Health Clinic 02.2014 January 2014 Public Health Clinic
12.2013 December 2013 Public Health Clinic 12.2013 December 2013 Public Health Clinic
07.2013 July 2013 Public Health Clinic 07.2013 July 2013 Public Health Clinic
01.2013 January 2013 Public Health Clinic 01.2013 January 2013 Public Health Clinic
07.2012 July 2012 Public Health Clinic FY 2013 07.2012 July 2012 Public Health Clinic FY 2013
01.2012 January 2012 Public Health Clinic 01.2012 January 2012 Public Health Clinic
09.2011 September 2011 Public Health Clinic 11.2011 09.2011 September 2011 Public Health Clinic 11.2011
02.2011 January 2011 Public Health Clinic 02.2011 January 2011 Public Health Clinic
07.2010 July 2010 Public Health Clinic 07.2010 July 2010 Public Health Clinic
02.2010 January 2010 Public Health Clinic 02.2010 January 2010 Public Health Clinic
07.2009 July 2009 Public Health Clinic 07.2009 July 2009 Public Health Clinic
01.2009 January 2009 Public Health Clinic 01.2009 January 2009 Public Health Clinic
07.2008 July 2008 Public Health Clinic 07.2008 July 2008 Public Health Clinic
01.2008 January 2008 Public Health Clinic 01.2008 January 2008 Public Health Clinic
10.2007 October 2007 Public Health Clinic 10.2007 October 2007 Public Health Clinic
01.2007 January 2007 Public Health Clinic 01.2007 January 2007 Public Health Clinic
07.2006 July 2006 Public Health Clinic 07.2006 July 2006 Public Health Clinic
01.2006 January 2006 Public Health Clinic 01.2006 January 2006 Public Health Clinic
07.2005 July 2005 Public Health Clinic 07.2005 July 2005 Public Health Clinic
01.2005 January 2005 Public Health Clinic 01.2005 January 2005 Public Health Clinic
01.2004 January 2004 Public Health Clinic 01.2004 January 2004 Public Health Clinic
07.2003 July 2003 Public Health Clinic 07.2003 July 2003 Public Health Clinic
01.2002 January 2002 Public Health Clinic 01.2002 January 2002 Public Health Clinic

Fee Schedules – Medicaid Mental Health

Youth Under 18

PDF
01/04/2017 January 2017 Medicaid Mental Health for Youth
11/22/2016 Integrated Co-Occurring Treatment Fees
07.01.2016 July 2016 Medicaid Mental Health for Youth
09.28.2015 October 2015 Medicaid Mental Health for Youth
07.2015 July 2015 Medicaid Mental Health for Youth
01.2015 January 2015 Medicaid Mental Health  for Youth
07.2014 July 2014 Medicaid Mental Health for Youth
03.2014 January 2014 Medicaid Mental Health for Youth
07.2013 July 2013 Medicaid Mental Health for Youth
08.2012 July 2012 Medicaid Mental Health  for Youth
09.2011 September 2011 Medicaid Mental Health for Youth
01.2011 January 2011 Medicaid Mental Health for Youth
08.2010 July 2010 Medicaid Mental Health for Youth

Adults 18 and Over

PDF
07.2016 July 2016 Medicaid Mental Health for Adults
12.17.2015 January 2016 Medicaid Mental Health for Adults Rev. 12.24.2015
07.2015 July 2015 Medicaid Mental Health for Adults
07.2014 July 2014 Medicaid Mental Health  for Adults
07.2013 July 2013 Medicaid Mental Health for Adults
01.2013 January 2013 Medicaid Mental Health for Adults
08.2012 July 2012 Medicaid Mental Health for Adults
08.2010 August 2010 Medicaid Mental Health for Adults
07.2008 July 2008 Medicaid Mental Health for Adults
10.2007 October 2007 Medicaid Mental Health for Adults
11.2006 November 2006 Medicaid Mental Health for Adults
07.2006 July 2006 Medicaid Mental Health for Adults
07.2004 July 2004 Medicaid Mental Health for Adults
07.2003 July 2003 Medicaid Mental Health for Adults

Fee Schedules – Mental Health Service Plan (MHSP)

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

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
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
12.30.2015 Addictive and Mental Disorders Division Changes to Prior Authorization
11.27.2015 Compound Drugs Billed on CMS-1500
11.03.2015 Services Exempt from Passport to Health Referral
10.09.2015 Montana Plan First – ICD-10 Update
10.07.2015 Compound Drugs Billed on CMS-1500
10.01.2015 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
07.08.2015 Montana Plan First – Revised List of Plan First Covered Services
06.19.2015 Vaccine Administration Code Update
06.09.2015 National Drug Code (NDC) Billing
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
10.08.2014 Vaccine Administration Code Update
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
06.06.2014 Changes to Prior Approval Requirement for Makena (Code J1725)
05.13.2014 PERM Provider Educational Webinars
03.18.2014 Information Regarding CMS-1500
01.29.2014 Centers for Medicare and Medicaid Services (CMS) ICD-10 Provider Readiness Assessment Update
01.28.2014 Vaccine Administration Code 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 Podiatrists and Medicaid Passport to Health Referrals
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)
09.11.2013 Electronic Funds Transfer (EFT) and Electronic Remittance Advice (ERA) Changes
09.03.2013 Changes to Contract with Magellan Medicaid Administration (MMA)
07.08.2013 Montana Medicaid DSM-5 Implementation
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
02.25.2013 Vaccine Administration Changes
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
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
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
09.07.2011 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
06.01.2011 17-AHP and Makena
04.12.2011 Request: Claims Submission, Date of Payment by June 30, 2011
02.07.2011 Vaccine Administration Code Update

2010

11.17.2010 17-AHP
11.17.2010 Compound Drugs Billed on a CMS-1500
10.05.2010 Changes to NCCI Edits
07.28.2010 Provider Record Update Procedures
07.14.2010 Medicaid Mental Health Services
06.23.2010 Cost Sharing Exemption under ARRA
06.22.2010 Electronic Health Records Link
05.28.2010 Clinical Laboratory Fee Schedule (CLFS) Instructions for Test Codes 80100, 80101, 80101 QW, G0430, G0430 QW, and G0431 QW
02.11.2010 Family Planning Clinic Billing Opportunity Will Expire on August 1, 2010
02.09.2010 United States 2010 Census
01.21.2010 Reimbursement Change for Psychiatric Residential Treatment Facilities and How It Affects Other Montana Medicaid Providers

Provider Notices 2002–2009

2009

10.08.2009 2009 H1N1 Influenza Vaccine and Administration 10.15.2009

10.01.2009 Healthy Montana Kids Plan

09.22.2009 NDC Billing Tools

07.28.2009 Family Planning Clinic Medicaid Billing Changes

06.02.2009 Clarification of Required NDC Information for Coverage of 17 Alpha-Hydroxyprogesterone Caproate (17-AHP)

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

07.10.2008 Multiple Conversion Factors for RBRVS Providers

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

04.10.2008 Billing Procedures Regarding National Drug Code (NDC) for Providers Using the CMS-1500 and 837-P

03.17.2008 Resubmission of Denied Claims 03.19.2008

03.11.2008 Billing Procedures Regarding National Drug Code (NDC) 10.15.2008

03.10.2008 NPI Reenrollment and Billing

02.19.2008 New HCPCS.CPT Codes

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

12.26.2007 WINASAP Upgrade Required for NDC Data Collection

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

11.30.2007 NDC Requirement on All Physician-Administered Drugs 01.17.2008

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®

10.03.2007 VFC Update

09.28.2007 Smoking and Tobacco Use Cessation Counseling

08.01.2007 Elimination of eSOR

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

2006

12.22.2006 Prior Authorization for DMEPOS and Medical and Surgical Procedures Updated Phone and Fax Lines

11.08.2006 Prior Authorization on the Move

09.22.2006 VFC Update

04.18.2006 VFC Update

03.01.2006 VFC Update

02.10.2006 New and Deleted Codes

01.05.2006 Increased Reimbursement for EPSDT Preventive Services

2000–2005

09.26.2005 Blood Draws (CPT 36415 and 36416)

07.28.2005 Scales – Congestive Heart Failure

02.04.2005 Introduction to Preferred Drug List

02.01.2005 New and Deleted Codes and New Botox Criteria

10.01.2004 Emergency Department Claims Appeal Process

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

12.23.2003 Chemical Dependency Procedure Code Changes

12.01.2003 High Risk Pregnant Women (HRPW) Changes

12.01.2003 Bilateral X-Ray Reimbursement Update

12.01.2003 Expanded Botox Criteria

12.01.2003 VFC Changes

12.01.2003 Discontinued Local Codes

11.10.2003 EMTALA Policy Change

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

07.28.2003 Hysterectomy Requirements

08.20.2003 Submitting HIPAA Compliant Claims – Information for All Providers

05.12.2003 Provider Rate and Payment Update

03.01.2003 Pharmacy Prior Authorization and Refill Changes

01.29.2003 Prescription Drug Update

01.10.2003 New Provider Notification Procedure and Medicaid Changes

01.02.2003 Drug Prior Authorization Updates

10.01.2002 Billing for Medicare Crossovers After Medicare's 45-Day Response Time

09.26.2002 DME Update

09.01.2002 Cost Sharing

07.01.2002 2.6% Reduction

06.20.2002 Passport to Health 24-Hour Availability

02.14.2002 Weekly Payment Available

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.

Plan First Medicaid Non-Covered Agreement 07.2012

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.