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. 12/10/2019 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 2020 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 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 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. 08/27/2015 MHSP Preferred Manufacturers 07/2015 Other Resources Dispensing Fee Questionnaire 09/2015 NCPDP D.0 Payer Sheet 08/2019 Rebateable Manufacturers 01/02/2020 SURS Provider Self-Audit Protocol 10/2015 To locate older documents, access the Archive Page.