General Information for Providers
Medicaid manual with general information for all provider type
Nursing Facility and Swing Bed Services
This manual has information specific to your provider type.
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
Proposed January 2023 Ancillary Services PDF
Proposed January 2023 Ancillary Services Excel
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
02/08/2024 Complex Care Add-On Structure
01/23/2024 Montana Healthcare Programs Support Services Holiday Closure REVISED
01/08/2024 Electronic Claim Adjustment Processing Change
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
10/30/2023 Medicaid Nursing Facility Reimbursement and Patient Contribution
09/15/2023 Claims Payment Discrepancy Update
09/14/2023 Claims Payment Discrepancy Identified
09/08/2023 Medicaid Claims Payment Delayed
09/06/2023 Provider Rate Increases Systematic Adjustments
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
06/28/2023 Nursing Facility QMB Claims
05/30/2023 Add-Ons Moving to Mountain-Pacific Quality Health
05/26/2023 Medicaid Reimbursement and Court Ordered Services REVISED
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
01/04/2023 Montana Healthcare Programs Support Services Holiday Closures
12/15/2021 Health Behavior Assessment and Intervention Billing Codes Rev. 04/26/2022
12/13/2021 MPATH Provider Services Portal Nursing Facilities Enrollment Information
12/10/2021 New Provider Services Portal
09/16/2021 Billing Update - Licensed Marriage and Family Therapist (LMFT)
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
05/17/2021 Process to Enter PASRR requests through the Qualitrac portal
04/02/2021 New Provider Type – Licensed Marriage and Family Therapist
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
12/07/2020 Medicaid Expansion Extended Through December 31, 2021
10/28/2020 Provider Relief Fund General Allocation
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
04/07/2020 Requirements and Billing for Telehealth Services by Nursing Facilities
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 Payment
Monthly Staffing Report Submission Page
Medicaid Cost Report Instructions
Medicaid Nursing Facility Add-On Application
Therapeutic Home Visit 72 Hours
Additional forms for all provider types are found on the Forms Page.
Level of care screening must be completed for Medicaid patients in order to receive Medicaid payments for nursing facility stays. The level of care screening must be requested prior to admission or Medicaid coverage as they may only be backdated 30 days if the individual meets level of care and has completed a Level I screen. Please review the information below regarding level of care.
Please review the following:
LOC Level of Care Screening Information
LOC Cover letter
LOC Flow Chart
LOC Determination form
If you have any questions about LOC(s), please contact Mountain Pacific Quality Health at (406) 443-0320 or (800) 219-7035. Questions can also be directed to the Community Services Bureau at (406) 444-4077.
Changes to the federal minimum data set (MDS) tool (Version 3.0 assessment), went into effect on October 1, 2010. One of these changes relates to Nursing Facilities (SNFs/NFs), States, and other qualified entities to identify individuals that are interested in returning to the community.
Frequently Asked Questions
Letter to Nursing Facilities
Community Alternatives
Your Discharge Planning Check List
A civil monetary penalty (CMP) is a monetary penalty the Centers for Medicare & Medicaid Services (CMS) may impose against skilled nursing facilities (SNF’s), nursing facilities (NF’s), and dually-certified SNF/NF for either the number of days or for each instance a facility is not in substantial compliance with one or more Medicare and Medicaid participation requirements for Long Term Care Facilities. A portion of CMP’s collected from facilities are returned to the States in which the CMP’s are imposed to provide grant funding to benefit nursing facility residents.
For more information, visit the Civil Monetary Penalties Grants site.
Montana's Long Term Care Ombudsman Program - Brochure
Assisted Living Facility - Assessment Checklist - Brochure
10 Tips for Choosing a Quality Long Term Care Facility - Brochure
Your Rights as a Nursing Home Resident - Brochure
Your Rights as a Assisted Living Facility Resident - Brochure