Pharmacy Pharmacy Prior Authorization Forms Claim Jumper Newsletters Provider Manuals General Information for Providers Medicaid manual with general information for all provider types. Prescription Drug Program This manual has information specific to your provider type. Preferred Drug Information Preferred Drug List Rev. 10/28/2020 List of preferred drugs and other preferred drug list information. Average Acquisition Cost Links AAC Rate Search Montana AAC List Submit Pricing Inquiry Provider Notices 2020 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 10/15/2020 Pharmacy Provider License Renewal Reminder 10/08/2020 Montana Plan First - Addition of Radiologic Examination Codes for Abdomen; 1, 2, and 3 Views 08/28/2020 Provider Relief Fund General Allocation rev. 08/28/2020 Overview and Access Guide for Seeking Provider Relief Funding from HHS Allocation to Medicaid Providers rev. 08/28/2020 08/11/2020 Provider Relief Fund General Allocation rev. 08/11/2020 Overview and Access Guide for Seeking Provider Relief Funding from HHS Allocation to Medicaid Providers rev. 08/11/2020 07/27/2020 Montana Plan First - Additional Covered Code, COVID - Testing 07/24/2020 Provider Relief Fund General Allocation Overview and Access Guide for Seeking Provider Relief Funding from HHS Allocation to Medicaid Providers 07/17/2020 Medicaid Reimbursement and Court Ordered Services 07/02/2020 New Required NCPDP Field 06/26/2020 Vaccine Administration by Pharmacists 06/17/2020 National Correct Coding Initiative Announcement 05/15/2020 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 FAQ for Suspension of Prior Authorizations or Continued Stay Reviews and Clinic Requirements for Some Medicaid Programs 04/06/2020 2020 Annual Montana Dispensing Fee Survey rev. 04/15/2020 04/06/2020 2020 Average Acquisition Cost (AAC) Survey 04/01/2020 Suspension of Face to Face Requirements for Some Medicaid Programs 03/26/2020 Montana Plan First - Additional Covered Codes, Telemedicine/Telehealth 03/20/2020 Billing for Insulin Products 03/19/2020 Telemedicine Medicaid Coverage and Reimbursement Policy for Telemedicine/Telehealth rev 03/27/2020 Frequently Asked Questions on Telemedicine / Telehealth 02/28/2020 Starting Dose and Quantity Limitations for Sedative Hypnotics 01/10/2020 Co-Payment Assessed in Error for January 6, 2020 01/03/2020 Changes to Hepatitis C Treatment Criteria 2019 12/27/2019 Elimination of Copayments 12/27/2019 Prior Authorization Criteria for Atypical Antipsychotics for Children 7 Years of Age and Under 12/16/2019 Guidance for Pharmacies Billing Prescriptions for Members in Psychiatric Residential Treatment Facilities (PRTF) 12/04/2019 Dosage Restrictions for all Opioids based on Morphine Milligram Equivalents (MME) 11/18/2019 HCPCS Modifiers - XE, XS, and XU (Reissued Notice) 11/14/2019 Prior Authorization Criteria for Synagis® 10/21/2019 Pharmacy Provider License Renewal Reminder 08/27/2019 Electronic Prior Authorization Process for Suboxone Films for Medication Assisted Therapy rev. 08/27/2019 07/25/2019 Cognitive Care Reimbursement (Revised) 07/09/2019 Vaccine Administration by Pharmacists 07/02/2019 Montana Plan First - Update to Covered Code List 06/21/2019 Electronic Prior Authorization Process for Suboxone Films for Medication Assisted Therapy 05/20/2019 Nurse Visit - Appropriate Billing Reminder - Revised Clarification rev. 05/30/2019 05/01/2019 Dosage Restrictions for all Opioids based on Morphine Milligram Equivalents (MME) 04/16/2019 2019 Annual Montana Dispensing Fee Survey 04/15/2019 2019 Average Acquisition Cost (AAC) Survey 03/25/2019 Montana Plan First - Change to Covered Procedures and Service Codes 2018 11/30/218 Dosage Restrictions for all Opioids based on Morphine Milligram Equivalents (MME) 11/20/2018 Appropriate Billing Reminder 11/20/2018 Appropriate Billing Reminder 11/09/2018 Pharmacy Provider License Reminder 11/08/2018 Rate Updates Mass Adjustment 11/06/2018 Smart PA® Prior Authorization for Synagis® 11/06/2018 Vaccine Administration by Pharmacists 11/05/2018 Rate Restoration Mass Adjustment for Pharmacy 10/19/2018 Medicaid Fee Schedules 08/14/2018 New Universal Claim Form 07/05/2018 Dosage Restrictions For All Opioids Based On Morphine Milligram Equivalents (MME) - this has been replaced with the provider notice dated 11/30/2018 07/02/2018 Updated CLIA Claims Editing 06/04/2018 Coding Resources Change 04/25/2018 Changes to the Medicare Part D Drug Benefit for Dual Eligible Members – Benzodiazepines 04/24/2018 2018 Annual Montana Dispensing Fee Survey 04/24/2018 2018 Average Acquisition Cost (AAC) Survey 04/04/2018 Updated Passport Eligible Populations & Reimbursement 02/26/2018 New Rendering Only Provider Enrollment Application 02/14/2018 Third Party Payer - Negative Payment Amounts 2017 08/18/2017 Clinical Pharmacists reviewed 04/2020 07/03/2017 Clinical Pharmacist Practictioner reviewed 04/2020 Drug Use Review (DUR) Board Montana Drug Use Review (DUR) Board / Formulary Committee Notification of upcoming meetings for drug use review, agendas, related meeting information, and minutes from past meetings. Drug Use Review Board Information on the Medicaid Drug Use Review Board. 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 MHSP Information 08/31/2015 MHSP Formulary Rev. Other Resources Dispensing Fee Questionnaire 09/2015 NCPDPD Payer Sheet 07/2020 Rebateable Manufacturers 10/01/2020 SURS Provider Self-Audit Protocol 10/2015 To locate older documents, access the Archive Page.