Claim Jumper Newsletters

Volume XXXIX Issue 3 - March 2024

SDMI Claim Submission and Timely Filing
The Importance of Effective Dates
Hospital Facility Utilization Fee 2023
Claim Adjustments
Recent Website Posts
Top 15 Claims Denials

Volume XXXIX Issue 2 - February 2024

Training for Caregivers of Those with Dementia
Unbundling Obstetrical Services on Bundles of Joy
EVV Implementation Update
Recent Website Posts
Top 15 Claims Denials

Volume XXXIX Issue 1 - January 2024

False Claims Act
Billing Outside the FQHC and RHC Prospective Payment System Rate
Recent Website Posts
Top 15 Claims Denials

 

Volume XXXVIII Issue 12 - December 2023

SURS Revelations: Appropriate Ambulance Billing
SDMI Waiver Serious Occurrence Reports
Money Follows the Person
Recent Website Posts
Top 15 Claims Denials
Provider Services Portal News: New Program for Crisis Services

Volume XXXVIII Issue 11 - November 2023

SURS Revelations: The More You Know
Recent Website Posts
Please Help Passport to Health Members Receive Care
House Bill 102 – An Act Revising Laws Related to Accrediting Agencies for Health Care Facilities
Top 15 Claim Denials
Severe Disabling Mental Illness (SDMI) Waiver Prior Authorizations (PAs)

Volume XXXVIII Issue 10 - October 2023

Durable Medical Equipment Rental Limits
Recent Website Posts
Top 15 Claim Denials
Nursing Facility Add-on Process
Usage Requirements of the Advanced Beneficiary Notice Form

Volume XXXVIII Issue 9 - September 2023

Provider Services Portal News: Provider Maintenance Update
Provider Services Portal News: Provider License Expiration Reminder Letters
Recent Website Posts
SURS Revelations: No More Tiers: Changes in IOP Services
Community Services Bureau Updates: Electronic Visit Verification
Community Services Bureau Updates: EVV Survey for Personal Care and Home Health Services
Top 15 Claim Denials

Volume XXXVIII Issue 8 - August 2023

Individual Provider Types
Recent Website Posts
PERM Medical Review Process
Top 15 Denial Reasons
Unlisted, Unspecified, Not Otherwise Classified Coding
CFC Development and Advisory Council
Provider Requirements for Residential Habilitation Adult Group Home Providers

Volume XXXVIII Issue 7 - July 2023

SURS Revelations: Creating a Successful Self-Audit Process
Recent Website Posts
SDMI Waiver Program: SDMI Claim Submission Issues
Top 15 Denial Reasons

Volume XXXVIII Issue 6 - June 2023

HMK: Discontinue Use of Healthy Montana Kids Application
Recent Website Posts
SURS Revelations: The Risks of Upcoding and Overbilling
SDMI Waiver Program: Provider Requirements for Residential Habilitation Assisted Living Providers
Top 15 Denial Reasons

Volume XXXVIII Issue 5 - May 2023

Provider Services: Location Addresses: When to Add
SURS Revelations: Sharing Is Not Always Caring
Recent Website Posts
SDMI Waiver Program: Life Coach Requirements
Top 15 Denial Reasons

Volume XXXVIII Issue 4 - April 2023

SURS Revelations: Billable FQHC & RHC Health Professionals
Recent Website Posts
Top 15 Denial Reasons

Volume XXXVIII Issue 3 - March 2023

PERM Medical Review Process and Common Findings
SURS Revelations: Records Maintenance for Physical Therapy, Occupational Therapy, or Speech Therapy.
Change to Youth Therapeutic Group Home Continued Stay Review Requirements. 
Recent Website Posts
Top 15 Denial Reasons

Volume XXXVIII Issue 2 - February 2023

OPA and Personal Resource/Patient Obligation Verification
Recent Website Posts
Top 15 Denial Reasons

Volume XXXVIII Issue 1 - January 2023

SURS Revelations: Provider Self Audits
Recent Website Posts
Top 15 Denial Reasons

Volume XXXVII Issue 12 - December 2022

PERM Medical Review Process
Provider Services Portal News:
     Adding a Program to Your Enrollment
Recent Website Posts
Top 15 Denial Reasons

Volume XXXVII Issue 11 - November 2022

Provider Services Portal News:
     Updating Provider Licenses
BHDD changes to Mental Health and SUD Treatment Programs Effective October 1, 2022
Recent Website Posts
Top 15 Denial Reasons

Volume XXXVII Issue 10 - October 2022

Provider Services Portal News:
     Schools and the MPATH Provider Services Portal
     Provider Services Portal Versus Fax and Mail
Recent Website Posts
Top 15 Denial Reasons

Volume XXXVII Issue 9 - September 2022

Provider Services Portal News:
     When to Disenroll a Provider
Montana Medicaid and TPL Part 4 of 4: Refunding the Department
Recent Website Posts
Top 15 Denial Reasons
SURS Revelations: Medical Records - When More Isn't Always Better

Volume XXXVII Issue 8 - August 2022

Provider Services Portal News:
     What to Do When a Provider Leaves Your Facility
Montana Medicaid and TPL Part 3 of 4: Establishing Provider Lien and Billing Medicaid for Tort Recovery Purposes
Recent Website Posts
Top 15 Denial Reasons

Volume XXXVII Issue 7 - July 2022

SURS Revelations: Written Therapy Orders
Provider Services Portal News:
     Provider Services Portal Versus Fax and Mail
     Important DEA/DEAX Information
Montana Medicaid and TPL Part 2 of 4: Full and Final Versus Adjustments to Pursue TPL
Top 15 Denial Reasons
Recent Website Posts
Who Ya Gonna Email?

Volume XXXVII Issue 6 - June 2022

SURS Revelations: Treatment Plan Documentation for Mental Health Services
Montana Medicaid and TPL Part 1 of 4: When is it appropriate to bill Medicaid?
Provider Services Portal News:
     Uploading Supplemental Documentation in the MPATH Provider Services Portal
     New Mailing Process Requires Cover Sheet
Recent Website Posts
Top 15 Denial Reasons

Volume XXXVII Issue 5 - May 2022

Provider Services Portal News:
     Changes Requiring a Technical Service Ticket
     Provider Revalidation
     When to Access the MPATH Provider Services Portal
PERM
Top 15 Denial Reasons
Recent Website Posts

Volume XXXVII Issue 4 - April 2022

Provider Services Portal Helpdesk Requests
SURS Revelations: Medication Assisted Treatment (MAT) Program
Electronic Adjustments - Void/Void Replace
Top 15 Denial Reasons
Recent Website Posts

Volume XXXVII Issue 3 - March 2022

The Nurse First Line is Ending
SURS Revelations: Medical Records - When More Isn't Always Better
Recent Website Posts
Top 15 Denial Reasons

Volume XXXVII Issue 2 - February 2022

MPATH Provider Services Portal News
Waiver for Additional Services and Populations (WASP) Application Process for Providers
SURS Revelations: Provider Adjustments and Self-Audits
Recent Website Posts
Top 15 Denial Reasons

Volume XXXVII Issue 1 - January 2022

MPATH Provider Services Portal Is Live!
Recent Website Posts
Top 15 Denial Reasons
Upcoming Trainings

Volume XXXVI Issue 12 - December 2021

Provider Services Module Go Live December 13, 2021!
SURS Revelations: “Excuse Me, Do You Have the Time?”
Field Rep Corner: Electronic Claim Adjustments Now Available!
Recent Website Posts
Top 15 Denial Reasons
Upcoming Trainings

Volume XXXVI Issue 11 - November 2021

SURS Revelations: What are Credit Balances?
Recent Website Posts
Top 15 Denial Reasons

Volume XXXVI Issue 10 - October 2021

SURS Revelations: Personal Health Information and Your Role in Keeping It Safe
Billing Update – Licensed Marriage and Family Therapist (LMFT)
Recent Website Posts
Top 15 Denial Reasons

Volume XXXVI Issue 09 - September 2021

Provider Services Module to Go Live Fall 2021!
SURS Revelations: The Importance of Documentation
Upcoming Trainings
Recent Website Posts
Top 15 Denial Reasons

Volume XXXVI Issue 08 - August 2021

New Provider Type: Licensed Marriage and Family Therapist
Recommend the Nurse First Advice Line to Members!
SURS Revelations: Provider Information, Medicaid, and You
Upcoming Trainings
Top 15 Denial Reasons
Recent Website Posts

Volume XXXVI Issue 07 - July 2021

Upcoming Trainings
Top 15 Denial Reasons
SURS Revelations: Unbundling Obstetrical Services on Bundles of Joy
Website Update
Recent Website Posts

Volume XXXVI Issue 06 - June 2021

Electronic Funds Transfer Reminder
Upcoming Trainings
Top 15 Denial Reasons
SURS Revelations: Sharing is Not Always Caring
Recent Web Posts

Volume XXXVI Issue 05 - May 2021
Upcoming Trainings
Top 15 Denial Reasons
Recent Website Posts

Volume XXXVI Issue 04 - April 2021
Upcoming Trainings
Recent Website Posts
Top 15 Denial Reasons

Volume XXXVI Issue 03 - March 2021
Waiver for Additional Services and Populations (WASP) Application Process
SURS Revelations: Dental Radiograph Records
Top 15 Denial Reasons
Recent Website Posts
Upcoming Trainings

Volume XXXVI Issue 02 - February 2021

Field Rep Corner: Individual Adjustment Requests 
FQHC & RHC Service Requirements 
Top 15 Denial Reasons 
Recent Website Posts
Upcoming Trainings 

Volume XXXVI Issue 01 - January 2021

PERM Medical Review Process Has Started
The National Diabetes Prevention Program in Montana
Field Rep Corner: Top 15 Denial Reason Codes
PPS Hospitals — Inpatient Bundled Services
Top 15 Denial Reasons
Recent Website Posts
SURS Revelations: Peer Support Services
Upcoming Trainings