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claims

 

Claim Instructions

 

Note: The most efficient way for claims to be submitted is electronically.
Claims submitted electronically are processed an average of 14 days faster than paper claims.
Paper claims submitted via mail are processed an average 12 days faster than paper claims submitted via fax.

There are two ways to submit claims to the Montana Healthcare Programs: Electronic and paper.  Electronic claims are processed much faster.  The information below is intended to support claim submission in both formats. The information is divided in two sections. The first section contains documents supporting electronic claim submissions. The second section contains documents supporting paper claim submissions.

Electronic Billing Instructions

NOTE: WINASAP-Windows 10 Issue

Due to recent Microsoft Windows Security updates, Windows 10 is no longer compatible with WINASAP.
EDI Gateway developers are addressing this issue, however, we do not currently have a timeline for resolution of this issue.
Please continue to check the Announcements for updates.

Electronic Billing Overview

Whether you submit one claim a month or hundreds, any provider can benefit from switching from paper to electronic billing. Whether by using the free WINASAP 5010 software or by using a clearinghouse to submit claims, electronic billing is faster, more accurate, and more secure.

You need a personal computer with Windows 98 and above to submit electronically via WINASAP 5010.

See Electronic Submission Setup below to begin the process.

For information about HIPAA 5010, click here.

Software Downloads and Users Guides

To bill claims electronically using the WINASAP software, a provider must enroll with Xerox EDI Solutions and download the WINASAP software from the Xerox EDI website.

WINASAP 5010 Software Download
WINASAP 5010 is a Windows-based electronic claims entry application for Montana Medicaid. If you have questions regarding WINASAP 5010, contact the EDI Support Unit at 1.800.987.6719.

WINASAP 5010 User Guide

WINASAP 5010 WebEx Presentation
For assistance using WINASAP, view the WebEx presentation and refer to the PDF version of the Montana Users Guide. Note: The WebEx is being re-recorded to accommodate the change to ICD-10. In the meantime, instructions that reference ICD-9 should be ICD-10.

WINASAP 5010  ICD-10 Training Nursing Facility Presentation 08.2015
For assistance using WINASAP, view the WebEx presentation and refer to the PDF version of the Montana Users Guide
WINASAP 5010 Montana Users Guide 10.2015

The Montana Users Guide contains important information required for billing. Answers to most questions can be found by referencing the Users Guide, including those regarding hardware requirements. Please read the Montana Users Guide prior to calling Provider Relations with questions. Technical support is limited for this free software.

 

Electronic Submission Setup

Follow the steps below to submit your Medicaid claims electronically.

STEP 1

Download the electronic billing enrollment forms and instructions below. Complete and submit the forms to the address/fax number listed on the enrollment form.

Clearinghouses or Billing Agents

EDI Submitter Enrollment Packet for X12N Transactions
All forms must be completed. This link opens the entire printable submitter packet for EDI enrollment (14 pages). To print individual sections, access the links below.

Individual Providers

EDI Provider Enrollment Packet for X12N Transactions
This link opens the entire printable provider packet for EDI enrollment (14 pages); however, providers may omit pages 1 and 6 of the EDI Provider Enrollment Form. To print individual sections, access the links below.

For multiple providers to appear on your drop-down list in the Montana Access to Health web portal, your NPI/API and submitter/trading partner number must be linked. To do so, complete and submit the form below.

STEP 2

Click WINASAP 5010 to download the WINASAP 5010 software directly to your computer.

  • You must have completed the enrollment packet and received your welcome letter before using the software.

  • Although the WINASAP software shows the default user as ADMIN this is not the same as Running as Administrator which you must do in order to not lose data. Refer to the manual for assistance.

  • Providers previously registered on the MATH web portal who have a Trading Partner ID and now want to bill electronically must call Provider Relations to ensure they have access.

  • Basic computer and keyboarding skills are necessary to use this software.

  • Technical support is limited for this free software.

STEP 3

For assistance using WINASAP, view the WebEx presentation below and download the PDF version of the Montana Users Guide.

Please read the Montana Users Guide prior to calling Provider Relations with questions.

Click on the WINASAP 5010 Montana Users Guide link to launch the user manual developed specifically for Montana providers. From there, you can save to your hard drive and/or print.

  • Although the WINASAP software shows the default user as ADMIN this is not the same as Running as Administrator which you must do in order to not lose data.

  • The Montana Users Guide contains important information required for billing. Answers to most questions can be found by referencing the Users Guide, including those regarding hardware requirements.

  • Technical support is limited for this free software.

Montana Healthcare Information, News Briefs, and Provider Notices


Methods for Submitting Claims 02.2014
Description of the methods providers may submit claims to Montana

Montana-Specific HIPAA 5010 Changes
Montana HIPAA 5010 information for providers.

Montana DPHHS Guidance for All Providers
Montana DPHHS guidance on submitting claims to DPHHS

Montana DPHHS Guidance for Pharmacies
Montana DPHHS guidance on submitting pharmacy claims to DPHHS.

Numeric Codes for HIPAA Mandated Transactions and Their Descriptions

Transaction and Code Sets Regulations

EDI Solutions Website Links Updated

The EDI Solutions website has changed. For Montana Medicaid, click on the EDI Solutions Clients tab and choose Montana Department of Public Health and Human Services.

WINASAP 5010 software can be found under the WINASAP tab. EDI enrollment information is available on the EDI Enrollment page. If you are having trouble finding information, contact Provider Relations via email at MTPRHelpdesk@conduent.com.

 

 

 

Instructions for Uploading Claims With 3rd Party Billing Software

List of Eligible Drug Manufacturers Updated

Montana Medicaid reimburses only for drugs that are manufactured by companies that have a signed rebate agreement with CMS. An updated list of these manufacturers has been posted on the provider type pages under Other Resources/Rebateable Manufacturers.

To determine if a manufacturer has signed a rebate agreement, check the first five digits of the National Drug Code (NDC) against the list. If there is no match, the drug is not reimbursable.

The list will be updated quarterly, so check regularly to assure coverage.

In addition, the valid NDC must be recorded on the claim (no spaces, no punctuation) as an 11-digit series of numbers. Claims will be denied for drugs billed without a valid 11-digit NDC. Providers also must be careful when entering the NDC quantity (the administered amount). A list of the most commonly used NDCs is available for providers.

For more information on billing with NDCs on a CMS-1500, refer to the provider notice dated April 10, 2008.

For more information on billing with NDCs on a UB-04, refer to the provider notice dated September 1, 2009.

NPI and Taxonomy Electronic Claim Instructions

Instructions for Billing Electronically

NPI and Taxonomy Paper Claim Instructions

Providers bill using their NPI and their taxonomy code or their atypical provider ID number.

Instructions for Completing the CMS-1500

CMS-1500 (02/12) As of April 1, 2014, this is the accepted version of the CMS-1500.

Instructions for Completing the UB-04

UB-04 Using NPI and Taxonomy
Sample ADA Dental Claim Form 06/2016

Paper Claim Instructions

NPI and Taxonomy Paper Claim Instructions

Paper Claim Instructions

Providers bill using their NPI and their taxonomy code or their atypical provider ID number.

Instructions for Completing the CMS-1500

CMS-1500 (02/12) As of April 1, 2014, this is the accepted version of the CMS-1500.

Instructions for Completing the UB-04

UB-04 Using NPI and Taxonomy
Sample ADA Dental Claim Form 06/2016

List of Eligible Drug Manufacturers Updated

Montana Medicaid reimburses only for drugs that are manufactured by companies that have a signed rebate agreement with CMS. An updated list of these manufacturers has been posted on the provider type pages under Other Resources/Rebateable Manufacturers.

To determine if a manufacturer has signed a rebate agreement, check the first five digits of the National Drug Code (NDC) against the list. If there is no match, the drug is not reimbursable.

The list will be updated quarterly, so check regularly to assure coverage.

In addition, the valid NDC must be recorded on the claim (no spaces, no punctuation) as an 11-digit series of numbers. Claims will be denied for drugs billed without a valid 11-digit NDC. Providers also must be careful when entering the NDC quantity (the administered amount). A list of the most commonly used NDCs is available for providers.

For more information on billing with NDCs on a CMS-1500, refer to the provider notice dated April 10, 2008.

For more information on billing with NDCs on a UB-04, refer to the provider notice dated September 1, 2009.