Prior Authorization Forms Claim Jumper Newsletters

General Information for Providers 

Medicaid manual with general information for all provider types.

Federally Qualified Health Center Services

This manual has information specific to your provider type.

Prescription Drug Program, Prior Authorization Chapter 


Prior authorization requirements and procedures are covered in this chapter.

Passport to Health 

Everything a provider needs to know to become a successful Passport provider.

For prescription medication notices, see the Pharmacy page/


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
07/06/2021 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

01/28/2021 Montana Healthcare Programs Support Services Holiday Closures
01/27/2021 Vaccines for Children (VFC) Code Update
01/21/2021 Montana Plan First Additional Codes Added to Plan First Covered Code List
1/11/2021 Provider Support Services Closed for Martin Luther King Day, Monday, January 18, 2021
01/05/2021 FQHC and RHC Requirements


12/23/2020 Diabetes Prevention Program (DPP) Information
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
10/08/2020 Montana Plan First - Addition of Radiologic Examination Codes for Abdomen; 1, 2, and 3 Views
10/02/2020 Reimbursement for CPT Code 90694 FLUAD Quadrivalent
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

07/20/2020 Outpatient Psychotherapy Limits
07/17/2020 Medicaid Reimbursement and Court Ordered Services
07/09/2020 Medicare Telehealth Requirement – Procedure Code G2025
06/17/2020 National Correct Coding Initiative Announcement
06/11/2020 Substance Use Disorder Billing Reminder
05/15/2020 Temporary Revision to Case Management General Provisions
05/01/2020 Telephone Services – Revenue Code 982
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

04/22/2020 Dental Telemedicine Notice
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
03/19/2020 Telemedicine Policy Clarification 

02/25/2020 Physician Administered Drug Update
02/20/20 Peer Support Services Revenue Code Update
01/10/2020 Co-Payment Assessed in Error for January 6, 2020

01/03/2020 Changes to Hepatitis C Treatment Criteria


12/27/2019 Elimination of Copayments
11/18/2019 HCPCS Modifiers - XE, XS, and XU (Reissued Notice)
11/15/2019 Chronic Care/Coordinated Care Codes Revised
11/14/2019 Circumcision Prior Authorization Changes Re-Issued from 2016
08/08/2019 FQHC and RHC Fee Schedule Reminder
07/23/2019  Peer Support Services
07/02/2019 Montana Plan First - Update to Covered Code List
05/20/2019 Nurse Visit - Appropriate Billing Reminder - Revised Clarification rev. 05/30/2019
03/25/2019 Montana Plan First - Change to Covered Procedures and Service Codes
03/20/2019 Prior Authorization Qualitrac Portal
02/27/2019 Billing Multiple Same-day Visits on a UB-04 or 837I and Condition Code G0 - Re-Issued Notice
02/21/2019 Dental Hygienist and Dental Hygienist with Limited Access Permit (LAP)
02/20/2019 Telehealth Originating Site Facility Fee
02/15/2019 DOT Medical Examination
01/17/2019 Physician Administered Drug Update


11/20/2018 Appropriate Billing Reminder
11/13/2018 Diabetes Prevention Program (DPP) Claims Update
11/08/2018 Rate Updates Mass Adjustment
10/19/2018 Medicaid Fee Schedules
10/03/2018 Vaccine for Children Code Update - Revised 
07/24/2018 Diabetes Prevention Program (DPP) Coding Change
07/17/2018 Caregiver Depression Screenings Reissued Notice
07/02/2018 Updated CLIA Claims Editing
06/04/2018 Coding Resources Change
05/24/2018 Reimbursement for LARCs
04/24/2018 Substance Use Disorder Treatment CPT Code Update rev. 05/09/2018
04/18/2018 New AMDD Medicaid Services Provider Manual for Substance Use Disorder and Adult Mental Health
04/04/2018  Updated Passport Eligible Populations & Reimbursement
03/02/2018 Physician Administered Drug Update rev. 03/08/2018
03/05/2018 Eligibility and Care Team Updates
03/02/2018 Physician Administered Drug Update
02/26/2018 New Rendering Only Provider Enrollment Application
02/21/2018 TCM Social Determinant Diagnosis Code Update
02/20/2018 Substance Use Disorder CPT Code Update
01/31/2018 Montana Healthcare Programs Covered Double Electric Breast Pumps - E0603
01/17/2018 Xgeva® Prior Authorization Criteria
01/12/2018 Zinplava Prior Authorization Criteria (Revised, provider types added)
01/12/2018 Infertility Treatment Code-J0725