Hospital Inpatient

Prior Authorization Forms Claim Jumper Newsletters

General Information for Providers  
Medicaid manual with general information for all provider types.
Hospital Inpatient Services 
This manual has information specific to your provider type.
Critical Access Hospitals 
This manual has information specific to critical access hospitals.

2021

09/28/2021 Laboratory Panel Billing
09/24/2021 Codes Removed from and Added to Plan First Covered Code List
09/23/2021 Prior Authorization Criteria for Synagis®
09/16/2021 Billing Update - Licensed Marriage and Family Therapist (LMFT)
09/16/2021 Off-Label Use of Ketamine
07/20/2021 Fetal Chromosomal Aneuploidy Testing
07/20/2021 Enrollment Update – Licensed Marriage and Family Therapist
07/06/2021 Adoption Of Temporary Emergency Rule To Allow for COVID-19-Related
Regulatory Discretion Beyond The Expiration Of The Governor-Declared State Of Emergency
06/11/2021 COVID-19 Vaccine Administration Billing Guidance 
05/05/2021 Date Spans for Prior Authorization Through the Qualitrac Portal
04/02/2021 
New Provider Type – Licensed Marriage and Family Therapist
01/28/2021  Montana Healthcare Programs Support Services Holiday Closures
01/21/2021 Montana Plan First Additional Codes Added to Plan First Covered Code List
01/11/2021  Provider Support Services Closed for Martin Luther King Day, Monday, January 18, 2021

2020

12/07/2020  Medicaid Expansion Extended Through December 31, 2021 
12/01/2020  Change in Application Process for Plan First
11/12/2020  Removal of Codes for COVID-19 Testing and Treatment
11/10/2020  Prior Authorization Criteria for Synagis®
10/28/2020  Provider Relief Fund General Allocation
10/08/2020 Montana Plan First - Addition of Radiologic Examination Codes for Abdomen; 1, 2, and 3 Views
09/29/2020  Inpatient Hospital APR-DRG Grouper Update
08/28/2020 Provider Relief Fund General Allocation rev. 08/28/2020

08/11/2020 Provider Relief Fund General Allocation rev. 08/11/2020

08/10/2020  Physician Administered Drug (PAD) Prior Authorization Requests - Revised
07/27/2020 Montana Plan First - Additional Covered Code, COVID - Testing
07/24/2020 Provider Relief Fund General Allocation

07/17/2020  Medicaid Reimbursement and Court Ordered Services
06/17/2020  National Correct Coding Initiative Announcement
5/15/2020  Temporary Revision to Case Management General Provisions
04/30/2020  National Correct Coding Initiative Announcement
04/28/2020  Temporary Suspension of the PCP Referral Requirement
04/27/2020  Non-Covered Services Agreement Policy Change

04/22/2020  Suspension of Prior Authorizations or Continued Stay Reviews and Clinical Requirements for Some Medicaid Programs


04/01/2020  Suspension of Face to Face Requirements for Some Medicaid Programs
03/19/2020  Telemedicine Medicaid Coverage and Reimbursement Policy for Telemedicine/Telehealth  rev 03/27/2020
03/19/2020  Telemedicine Policy Clarification 

01/10/2020  Co-Payment Assessed in Error for January 6, 2020

2019

12/27/2019 Elimination of Copayments
12/06/2019 UR New Implementation date and Provider Portal Training 
11/22/2019  New Early and Periodic Screening, Diagnostic and Treatment (EPSDT) Review and
                    Process through Qualitrac Portal
11/18/2019 HCPCS Modifiers - XE, XS, and XU (Reissued Notice)
11/15/2019 Chronic Care/Coordinated Care Codes Revised
11/14/2019 Prior Authorization Criteria for Synagis®
11/14/2019  Circumcision Prior Authorization Changes Re-Issued from 2016
09/27/2019 Reimbursement Rate Change
07/02/2019 Montana Plan First - Update to Covered Code List
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