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Claims Instructions

Claims Instructions

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

Sample ADA Dental Claim Form 06.2016