Hospital Inpatient Hospital Inpatient Prior Authorization Forms Claim Jumper Newsletters Provider Manuals General Information for Providers 05/2019 Medicaid manual with general information for all provider types. Hospital Inpatient Services 06/2018 This manual has information specific to your provider type. Critical Access Hospitals 06/2018 This manual has information specific to critical access hospitals. Medicaid Rules and Regulations Code of Federal Regulations (Title 42) Montana Code Annotated - https://leg.mt.gov/ (Choose “Laws & Bills” then “ Montana Statutes – MCA”) Applicable Section: Title 53, Chapter 6 Administrative Rules of Montana (Title 37) Chapter 79 Healthy Montana Kids Chapter 82 Medicaid Eligibility Chapter 83 Medicaid for Certain Medicare Beneficiaries and Others Chapter 85 General Medicaid Services Chapter 86 Medicaid Primary Care Services Fee Schedules - Hospital - APR DRG October 2019 APR-DRG Excel January 2019 APR-DRG Excel rev. 05/10/2019 July 2018 APR-DRG Excel rev. 02/19/2019 March 2018 APR-DRG Excel rev. 12/17/2018 January 2018 APR-DRG Calculator Excel rev. 12/17/2018 Provider Notices 2019 10/01/2019 Chronic Care/Coordinated Care Codes 09/27/2019 Reimbursement Rate Change 07/25/2019 Cognitive Care Reimbursement (Revised) 07/02/2019 Montana Plan First - Update to Covered Code List 06/28/2019 Cognitive Care Reimbursement 06/28/2019 Cognitive Care Reimbursement 06/12/2019 Unlisted Billing Codes Reminder 05/20/2019 Nurse Visit - Appropriate Billing Reminder - Revised Clarification rev. 05/30/2019 03/25/2019 Montana Plan First - Change to Covered Procedures and Service Codes 03/20/2019 Prior Authorization Qualitrac Portal 02/20/2019 Reimbursement Rate Change 02/20/2019 Telehealth Originating Site Facility Fee 2018 11/20/2018 Appropriate Billing Reminder 11/08/2018 Rate Updates Mass Adjustment 11/06/2018 Smart PA® Prior Authorization for Synagis® 10/19/2018 Medicaid Fee Schedules 10/09/2018 CT of the Brain and MRI of the Head Tips 07/02/2018 Updated CLIA Claims Editing 06/12/2018 Approved Diagnosis Codes for Botox 06/04/2018 Coding Resources Change 05/30/2018 Panniculectomy Criteria 05/01/2018 Condition Code - LARC Immediately After Delivery 04/24/2018 Present on Admission (POA) Billing Update 04/24/2018 Out-Of_state Inpatient Admissions Prior Authorization 04/18/2018 New AMDD Medicaid Services Provider Manual for Substance Use Disorder and Adult Mental Health 04/04/2018 Updated Passport Eligible Populations & Reimbursement 02/26/2018 New Rendering Only Provider Enrollment Application 02/15/2018 Reimbursement Rate Change 01/31/2018 Montana Healthcare Programs Covered Double Electric Breast Pumps - E0603 01/30/2018 Fetal Chromosomal Aneuploidy Testing 01/22/2018 HCPCS code G0515 replaces 97532 01/12/2018 Infertility Treatment Code-J0725 2017 12/29/2017 Prior Authorization for Transgender Mastectomy/Breast Augmentation 12/29/2017 Prior Authorization for Gender Reassignment Surgery 12/26/2017 MATH Web Portal Eligibility Inquiry Verification Update 12/26/2017 Inpatient Reimbursement Rate 12/26/2017 CAH Reimbursement Rate 12/18/2017 Fetal Chromosomal Aneuploidy Testing 12/11/2017 Montana Plan First Procedure and Service Codes - Contraceptive (IUD) Update 12/01/2017 Montana Medicaid Expansion Prior Authorization Changes 11/21/2017 Severe Disabling Mental Illness (SDMI) rev. 11/22/2017 11/20/2017 Qualified Medicare Beneficiary (QMB) Claim Adjustments 11/13/2017 Smart PA® Prior Authorization for Synagis® 11/02/2017 New Medicare Card 10/02/2017 Montana Medicaid Expansion Changes 09/14/2017 Montana Plan First Anesthesia Update 08/21/2017 Clinical Pharmacist Practitioner 08/01/2017 Telemedicine - Correction 05/26/2017 Federal Final Rule, "Nondiscrimination in Health Program and Activities” and Implication for Coverage of Services Related to Gender Transition 05/15/2017 OOS Adult Acute Mental Health Inpatient Hospital Prior Authorizations 05/01/2017 Vaccine Administration Code Update 04/24/2017 Unlisted Services or Procedures Reminder 04/20/2017 Plan First Hysterectomy codes added effective April 1, 2017 04/06/2017 New EPSDT Request Form 04/04/2017 PA Criteria for Artificial Disc Replacement 04/04/2017 Criteria for Orthognathic Surgery 04/04/2017 Changes to Medical Surgical PA 04/04/2017 Criteria for Panniculectomy 02/23/2017 Mass Adjustment to Correct the Base Rate Calculation 02/02/2017 EPSDT ( Children's) Lead Screening Requirements Other Resources Prior Authorization Criteria for Specific Services Rebateable Manufacturers 10/02/2019 SURS Provider Self-Audit Protocol 10.2015 To locate older documents, access the Archive Page.