Pharmacy Pharmacy Provider Manuals General Information for Providers 06/2018 Medicaid manual with general information for all provider types. Prescription Drug Program 11/2018 This manual has information specific to your provider type. Preferred Drug Information Preferred Drug List Rev. 01/24/2019 List of preferred drugs and other preferred drug list information. Average Acquisition Cost Links AAC Rate Search Montana AAC List Submit Pricing Inquiry 06/27/2016 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 11/30/218 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 12/26/2017 MATH Web Portal Eligibility Inquiry Verification Update 12/11/2017 Montana Plan First Procedure and Service Codes - Contraceptive (IUD) Update 12/12/2017 Medication Authorization Change Regarding New Brand Name Drugs 12/11/2017 Vaccines for Children Code Update 12/01/2017 Montana Medicaid Expansion Prior Authorization Changes 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 09/14/2017 NCPDP Payer Sheet Update 09/05/2017 Medication Authorization Changes Rev. 09/21/2017 08/21/2017 Clinical Pharmacist Practitioner 08/14/2017 Medication Authorization Changes 08/01/2017 Telemedicine - Correction 07/03/2017 Clinical Pharmacist Practitioner 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 2017 Average Acquisition Cost (AAC) Survey 05/09/2017 2017 Annual Montana Dispensing Fee Survey 04/20/2017 Plan First Hysterectomy codes added effective April 1, 2017 04/11/2017 Medication Authorization Changes 04/06/2017 New EPSDT Request Form 03/31/2017 Ketone Test Strips - A4250 & A252 2016 PDF: 11/30/2016 EnLyte® TXT: 11/30/2016 EnLyte® PDF: 11/21/2016 Humira Unit Submission TXT: 11/21/2016 Humira Unit Submission PDF: 11/21/2016 PA for Methadone TXT: 11/21/2016 PA for Methadone PDF: 11/03/2016 Smart PA® for Synagis® Revised 11/15/2016 TXT: 11/03/2016 Smart PA® for Synagis® Revised 11/15/2016 PDF: 09/26/2016 Coverage of Weighted Blankets TXT: 09/26/2016 Coverage of Weighted Blankets PDF: 08/12/2016 Vaccine Administration by Pharmacists TXT: 08/12/2016 Vaccine Administration by Pharmacists PDF: 08/12/2016 Removal of 15-day Supply Limit on Initial Atypical Antipsychotic Prescriptions TXT: 08/12/2016 Removal of 15-day Supply Limit on Initial Atypical Antipsychotic Prescriptions PDF: 07/28/2016 Montana Plan First Preventive Code Additions TXT: 07/28/2016 Montana Plan First Preventive Code Additions PDF: 07/18/2016 Changes to Member Cost Share Update TXT: 07/18/2016 Changes to Member Cost Share Update PDF: 06/27/2016 Reverse and Rebill for Drug Cost Disputes TXT: 06/27/2016 Reverse and Rebill for Drug Cost Disputes PDF: 06/27/2016 Average Acquisition Cost Reimbursement Methodology TXT: 06/27/2016 Average Acquisition Cost Reimbursement Methodology PDF: 05/19/2016 Changes to Member Cost Share TXT: 05/19/2016 Changes to Member Cost Share PDF: 04/06/2016 Hepatitis C Prior Authorization Streamlined Request Form TXT: 04/06/2016 Hepatitis C Prior Authorization Streamlined Request Form PDF: 03/04/2016 Vaccine Administration by Pharmacists for Adolescents Age 12-18 Years TXT: 03/04/2016 Vaccine Administration by Pharmacists for Adolescents Age 12-18 Years 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: 01/15/2016 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 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 (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. 08/27/2015 MHSP Preferred Manufacturers 07/2015 Other Resources Dispensing Fee Questionnaire 09/2015 NCPDP D.0 Payer Sheet 09/2017 Rebateable Manufacturers 01/2019 SURS Provider Self-Audit Protocol 10/2015 To locate older documents, access the Archive Page.