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Department of Public Health and Human Services

Montana Healthcare Programs Provider Information » Hospital Inpatient

Main Content

Hospital Inpatient

Hospital Inpatient

Provider Manuals

General Information for Providers 06/2018
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

Fee Schedules - Hospital - APR DRG

APR - DRG FAQ (rev. 02/08/2018)

 

Some documents on this page are legal and/or historical in nature and cannot be altered to meet 508 Accessibility standards.  Each of those documents has a corresponding .txt document with the same name placed next to it.

July 2018 APR-DRG Excel

March 2018 APR-DRG PDF rev. 04/17/2018
March 2018 APR-DRG Excel rev. 04/17/2018


January 2018 APR-DRG Calculator PDF rev. 03/02/2018
January 2018 APR-DRG Calculator Excel rev. 04/06/2018
October 2016

PDF: October 2016 APR-DRG Calculator Rev. 09/19/2017
Excel: October 2016 APR-DRG Calculator Rev. 09/19/2017
TEXT: October 2016 APR-DRG Calculator Rev. 09/19/2017

Provider Notices

Some documents on this page are legal and/or historical in nature and cannot be altered to meet 508 Accessibility standards.  Each of those documents has a corresponding .txt document with the same name placed next to it.

2018

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

2016

PDF: 11/01/2016 Smart PA® for Synagis® Revised 11/15/2016
TXT:  11/01/2016 Smart PA® for Synagis® Revised 11/15/2016
PDF: 10/28/2016 ICD 10 Updates and Coding Changes Revised 12/07/2016
TXT:  10/28/2016 ICD 10 Updates and Coding Changes Revised 12/07/2016
PDF: 10/18/2016 Inpatient PPS Hospital Stays with Split Medicaid eligibility and the HELP TPA Plan through BCBS - Revised 10/21/2016
TXT:  10/18/2016 Inpatient PPS Hospital Stays with Split Medicaid eligibility and the HELP TPA Plan through BCBS - Revised 10/21/2016
PDF: 09/27/2016 Physician Administered Drugs - NDC Requirements Revised
TXT:  09/27/2016 Physician Administered Drugs - NDC Requirements Revised
PDF: 07/28/2016 Montana Plan First Preventive Code Additions
TXT:  07/28/2016 Montana Plan First Preventive Code Additions
PDF: 07/25/2016 Admission Date and Statement Covers Period - Revised 07/18/2016
TXT:  07/25/2016 Admission Date and Statement Covers Period - Revised 07/18/2016
PDF: 07/18/2016 Changes to Member Cost Share Update
TXT:  07/18/2016 Changes to Member Cost Share Update
PDF: 07/12/2016 Vaccine Administration Code Update
TXT:  07/12/2016 Vaccine Administration Code Update
PDF: 07/05/2016 PA For Botox No Longer Required
TXT:  07/05/2016 PA For Botox No Longer Required
PDF: 07/05/2016 Circumcision Prior Authorization Changes
TXT:  07/05/2016 Circumcision Prior Authorization Changes
PDF: 07/01/2016 Admission Date and Statement Covers Period
TXT:  07/01/2016 Admission Date and Statement Covers Period
PDF: 05/19/2016 Changes to Member Cost Share
TXT:  05/19/2016 Changes to Member Cost Share
PDF: 02/01/2016 Basic Medicaid Benefit Increased to Standard Medicaid Benefit
TXT:  02/01/2016 Basic Medicaid Benefit Increased to Standard Medicaid Benefit
PDF: 01/28/2016 LARC Inserted at Time of Delivery in PPS Hospital
TXT:  01/28/2016 LARC Inserted at Time of Delivery in PPS Hospital
PDF: 01/15/2016 Standard Medicaid and HELP Plan Claims Processing Rev/ 01/19/2016
TXT:  01/15/2016 Standard Medicaid and HELP Plan Claims Processing Rev/ 01/19/2016
PDF: 01/15/2016 Hospital Grade Electric Breast Pump Requirements
TXT:  01/15/2016 Hospital Grade Electric Breast Pump Requirements

 

Other Resources

To locate older documents, access the Archive Page.