Durable Medical Equipment, Prosthetics, Orthotics, and Supplies

Prior Authorization Forms Claim Jumper Newsletters

General Information for Providers  
Medicaid manual with general information for all provider types.

Durable Medical Equipment, Prosthetics, Orthotics, and Medical Supplies (DMEPOS) 
This manual has information specific to your provider type.

2024

10/18/2024 Electronic Adjustments Void or Void/Replace
10/15/2024 Revalidation Requirements Deadline
07/29/2024 Prior Authorization Requirements When a Member Has Third Party Liability
06/28/2024 January 1, 2024 and July 1, 2024 Fee Schedule Updates
06/20/2024 DME Claims Processing Instructions - Enteral Nutrition Supplies
06/18/2024 Method for Submitting Durable Medical Equipment Prior Authorizations
06/18/2024 DEA Number Required for Prescribers REVISED
06/11/2024 Health Resources Division Claims Appeal Process
05/21/2024 DEA Number Required for Prescribers
05/01/2024 Paperwork Attachments Submission Timing for Electronic Claims
05/01/2024 Eligibility Inquiry and Service Type Code in the MATH Portal
04/19/2024 DME Claims Processing Instructions - Prior Authorization Required to Exceed Maximum Units
04/19/2024 Changes Regarding Opioid Prior Authorization and Medication for Opioid Use Disorder
04/08/2024 Negative Pressure Wound Therapy Pumps (E2402) Do Not Require Prior Authorization
03/27/2024 HHS Letter to Healthcare Providers
03/27/2024 Resources for Providers in Response to the Change Healthcare Cyberattack
03/27/2024 Updated CLIA Claims Editing
03/27/2024 Avoiding Claim Denials
03/27/2024 Location Address and Provider Maintenance Updates
03/19/2024 Electronic Funds Transfer Payment Verification
03/12/2024 Valid Member ID and Eligibility Verification
03/12/2024 Provider Initiated Claims Adjustment
03/05/2024 Voiding Claims With a Prior Authorization
01/26/2024 Criteria Update for Gait Trainers - EPSDT Only
01/23/2024 Montana Healthcare Programs Support Services Holiday Closure REVISED
01/08/2024 Electronic Claim Adjustment Processing Change

2023

12/22/2023 Passport Provider Referral Number on Claims
12/12/2023 Individual Providers Enrolled as Sole Proprietors Due for Revalidation
11/08/2023 Prior Authorization Information
10/31/2023 Managed Care Referrals IHS, Tribal 638, and Urban Indian Organizations REVISED
10/06/2023 Reminder DME Prior Authorization Requirements
09/28/2023 Medical Food or Formula for Phenylketonuria (PKU) Due to Inborn Errors of Metabolism (IEM) REVISED
09/15/2023 Claims Payment Discrepancy Update
09/14/2023 Claims Payment Discrepancy Identified
09/08/2023 Medicaid Claims Payment Delayed
08/01/2023 Provider License Expiration Reminder Letters
07/06/2023 Provider Rate Increases
06/28/2023 Wheelchair and Bariatric Equipment Coverage for Nursing Facility Residents
06/02/2023 New Hearing Aid Review and Approval Process Through Qualitrac Portal
06/01/2023 Billing Guidance for Tracheostomy Tubes for Members Aged 20 and Under
05/26/2023 Medicaid Reimbursement and Court Ordered Services REVISED
05/01/2023 Non-Adjunctive (Therapeutic) and Adjunctive (Non-Therapeutic) Continuous Glucose Monitors (CGMs) Policy Revision
04/10/2023 Resumption of Face-to-Face Requirements for Selected Programs REVISED
03/22/2023 Coverage and Reimbursement Policy for Telemedicine/Telehealth Services
03/22/2023 End of Public Health Emergency (PHE) Effects on Pharmacy Coverage
03/22/2023 Non-Covered Services Agreement Policy Return to Requirements
03/22/2023 Reinstatement of the Primary Care Provider Referral for Passport
03/22/2023 Resumption of Face-to-Face Requirements for Selected Programs
03/22/2023 Resumption of Prior Authorization Requirements Revised 04/03/2023
03/17/2023 End of Temporary Revision to Case Management General Provisions
03/10/2023 Provider Meetings for Medicaid Eligibility Redetermination and Unwinding PHE Flexibilities
03/09/2023 Add-on and E&M Code Editing
03/03/2023 End of Public Health Emergency
01/31/2023 Omnipod Coverage
01/04/2023 Montana Healthcare Programs Support Services Holiday Closures

2022

08/05/2022 Bipartisan Budget Act of 2018 Cost Avoidance Statute Changes
06/03/2022 New Early and Periodic Screening, Diagnostic and Treatment (EPSDT) Review and Process through Qualitrac Portal REISSUED
05/16/2022 Help Members Receive Important Information from Montana Medicaid and Stay Covered
05/13/2022 Revalidation Extended REVISED
05/13/2022 National Drug Code (NDC) Denial Errors
05/11/2022 Prior Authorization Qualitrac Portal REISSUED
04/26/2022 Health Behavior Assessment and Intervention Billing Codes REVISED
03/29/2022 Nurse First Advice Line Services Ending
03/16/2022 Revalidation Extended to June 2022 REVISED Rev. 05/13/2022
02/23/2022 Revalidation Extended to June 2022 Rev. 03/16/2022
02/23/2022 Standing Orders and Medicaid Reimbursement
01/14/2022 Montana Healthcare Programs Support Services Holiday Closures
01/03/2022 Non-Therapeutic CGM Devices

2021

12/15/2021 Health Behavior Assessment and Intervention Billing Codes Rev. 04/26/2022
12/10/2021 New Provider Services Portal
11/02/2021 Therapeutic Continuous Glucose Monitor (CGM) Devices
09/16/2021 Billing Update - Licensed Marriage and Family Therapist (LMFT)
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
03/01/2020 DME and DME EPSDT Prior Authorizations Through the Qualitrac Portal
01/28/2021 Montana Healthcare Programs Support Services Holiday Closures
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 
11/17/2020 Prior Authorizations Through the Qualitrac Web Portal for DME and DME EPSDT
10/28/2020 Provider Relief Fund General Allocation
09/10/2020 HMK-CHIP DMEPOS Claims Administration Change
08///28/2020 Provider Relief Fund General Allocation rev. 08/28/2020

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

07/24/2020 Provider Relief Fund General Allocation

07/17/2020 Medicaid Reimbursement and Court Ordered Services
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


04/01/2020 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

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

Noridian Administrative Services
Medicare's DME Administrative Services provider.

Prior Authorization Criteria for Specific Services

Region D DMERC/CIGNA Medicare
The Durable Medical Equipment Regional Carriers (DMERC) website. DMERC processes Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) for Medicare.

Medicare Pricing, Data Analysis, and Coding (PDAC)
This website assists manufacturers and suppliers with DMEPOS billing and coding information. Can call toll-free 1-877-735-1326 or e-mail DME PDAC using their contact form.

SURS Provider Internal Self-Review Protocol 10/2023

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