Pharmacy

Prior Authorization Forms Claim Jumper Newsletters

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 List 09/16/2021

List of preferred drugs and other preferred drug list information.

 

2021

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)
07/20/2021 Enrollment Update – Licensed Marriage and Family Therapist
07/09/2021 2021 Annual Montana Dispensing Fee Survey
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
05/12/2021 2021 Average Acquisition Cost (AAC) Survey
04/26/2021 Billing for COVID-19 Vaccine
04/08/2021 Electronic Prior Authorization Process for Suboxone® Films for Medication Assisted Therapy
04/02/2021 
New Provider Type – Licensed Marriage and Family Therapist
02/11/2021 Billing for COVID-19 Vaccine
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
10/15/2020 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

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

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
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


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

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

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.