Tribal 638
General Information for Providers
Medicaid manual with general information for all provider types.
Tribal 638 Provider Manual
This manual has information specific to your provider type.
Tribal Health Improvement Program (T-HIP) Manual
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
How to become a successful Passport provider.
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
July 2024 Tribal 638 Fee Schedule
January 2024 Tribal 638 Fee Schedule
July 2023 Tribal 638 Fee Schedule
January 2023 Indian Health Service and Tribal 638 Fee Schedule
September 2022 Indian Health Service and Tribal 638 Fee Schedule
July 2022 Indian Health Service and Tribal 638 Fee Schedule
January 2022 Indian Health Service and Tribal 638 Fee Schedule
November 2021 Indian Health Service and Tribal 638 Fee Schedule
July 2021 Indian Health Service and Tribal 638 Fee Schedule
January 2021 Indian Health Service and Tribal 638 Fee Schedule
July 2020 Indian Health Service and Tribal 638 Fee Schedule
January 2020 Indian Health Service and Tribal 638 Fee Schedule rev. 04/24/2020
2024
11/04/2024 Paper Claim Denials
10/30/2024 Beyfortus and Synagis Coverage for RSV Prophylaxis
10/18/2024 Electronic Adjustments Void or Void/Replace
10/15/2024 Revalidation Requirements Deadline
07/26/2024 Peer Support Services for Dual Eligible Members
07/22/2024 Qualifying Visits for Prospective Payment System Reimbursement
06/28/2024 January 1, 2024 and July 1, 2024 Fee Schedule Updates
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 Changes Regarding Opioid Prior Authorization and Medication for Opioid Use Disorder
04/05/2024 Written Orders for Physical, Occupational, and Speech Therapy
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
02/14/2024 How to Obtain a Double Electric Breast Pump, HCPCS E0603
02/14/2024 Medicaid 12-Month Postpartum Continuous Eligibility Coverage
01/23/2024 Montana Healthcare Programs Support Services Holiday Closure REVISED
01/17/2024 Prior Authorization Criteria for Atypical Antipsychotics for Children 8 Years of Age and Under REVISED
01/08/2024 AMP Cap Removal and Medication Access
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
11/01/2023 Beyfortus and Synagis Coverage for RSV Prophylaxis
10/31/2023 Managed Care Referrals IHS, Tribal 638, and Urban Indian Organizations REVISED
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
08/18/2023 Case Management and Medication Assisted Treatment (MAT) Services
08/01/2023 Provider License Expiration Reminder Letters
07/06/2023 Provider Rate Increases
06/01/2023 Billing Guidance for Tracheostomy Tubes for Members Aged 20 and Under
05/30/2023 Substance Use Disorder Billing Reminder REVISED
05/26/2023 Medicaid Reimbursement and Court Ordered Services REVISED
05/08/2023 Diabetes Prevention Program (DPP) Information REVISED
05/05/2023 Medicaid Coverage of Abortion Services REVISED
05/03/2023 End of PHE Pharmacy Signature Requirements
05/03/2023 Makena PV Makena (Hydroxyprogesterone Caproate Injection) Coverage
05/01/2023 Non-Adjunctive (Therapeutic) and Adjunctive (Non-Therapeutic) Continuous Glucose Monitors (CGMs) Policy Revision
05/01/2023 Medicaid Coverage of Abortion Services
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
12/23/2022 Plan First Updated Code List Descriptions
09/19/2022 New Plan First Covered Code
09/13/2022 New Medicaid Reimbursement Opportunity for Substance Use Disorder and Mental Health
08/05/2022 Bipartisan Budget Act of 2018 Cost Avoidance Statute Changes
07/12/2022 After-Hours Crisis Line Services
06/17/2022 Plan First Updated Code List Descriptions
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 Peer Support Services 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
02/28/2022 COVID-19 At-Home Test Coverage
02/23/2022 Revalidation Extended to June 2022 Rev. 03/16/2022
02/23/2022 Standing Orders and Medicaid Reimbursement
02/02/2022 Dose Limitations for Gabapentinoids
01/14/2022 Montana Healthcare Programs Support Services Holiday Closures
01/03/2022 Non-Therapeutic CGM Devices
2021
12/20/2021 Plan First Updated Code List Descriptions
12/15/2021 Health Behavior Assessment and Intervention Billing Codes Rev. 04/26/2022
12/10/2021 New Provider Services Portal
11/03/2021 New Medicaid Reimbursement Opportunity for Physical Therapy Services
11/02/2021 Therapeutic Continuous Glucose Monitor (CGM) Devices
09/24/2021 Codes Removed from and Added to Plan First Covered Code List
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
04/08/2021 Electronic Prior Authorization Process for Suboxone® Films for Medication Assisted Therapy
04/02/2021 New Provider Type – Licensed Marriage and Family Therapist
03/01/2020 DME and DME EPSDT Prior Authorizations Through the Qualitrac Portal
01/28/2021 Montana Healthcare Programs Support Services Holiday Closures
01/21/2021 Montana Plan First Additional Codes Added to Plan First Covered Code List
01/11/2021 Provider Support Services Closed for Martin Luther King Day, Monday, January 18, 2021
2020
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
11/17/2020 Prior Authorizations Through the Qualitrac Web Portal for DME and DME EPSDT
11/12/2020 Removal of Codes for COVID-19 Testing and Treatment
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
08/28/2020 Provider Relief Fund General Allocation rev. 08/28/2020
- Overview and Access Guide for Seeking Provider Relief Funding from HHS Allocation to Medicaid Providers rev. 08/28/2020
08/11/2020 Provider Relief Fund General Allocation rev. 08/11/2020
- Overview and Access Guide for Seeking Provider Relief Funding from HHS Allocation to Medicaid Providers 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
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 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
02/28/2020 Starting Dose and Quantity Limitations for Sedative Hypnotics
02/20/2020 Peer Support Services Revenue Code Update
01/03/2020 Changes to Hepatitis C Treatment Criteria
10/15/2024 HIPAA Information and Resources
09/19/2024 Medicaid Eligibility Refresher Presentation
07/16/2024 Administrative Rules Presentation
06/18/2024 Durable Medical Equipment Presentation
04/16/2024 National Diabetes Prevention Program Presentation
02/20/2024 Montana Medicaid Reimbursable Services Presentation
09/19/2023 Plan First Waiver - Family Planning Presentation
08/15/2023 IHS Tribal MPATH Portal Training
06/21/2023 Healthy Montana Kids
03/21/2023 Nutrition Security in Healthcare
02/21/2023 Non-Emergency Medical Transportation Presentation
01/17/2023 Money Follows the Person Demonstration Project Training MFP Project Facts Sheets
11/15/2022 Medicaid Refresher Training
09/20/2022 Passport to Health Training
08/16/2022 Durable Medical Equipment IHS Tribal Training
06/21/2022 SURS IHS Tribal Training
05/24/2022 IHS Pharmacy Training
04/19/2022 Montana Medicaid Training
03/15/2022 MPATH Provider Services Module Presentation
11/24/2021 Diabetes Self-Management Education Support Services
01/27/2021 Montana Diabetes Prevention Program Overview Presentation
09/25/2018 Community First Choice/Personal Assistance Services Big Sky Waiver Overview
08/28/2018 Medicaid Provider Enrollment in PDF
01/28/2018 Pharmacy Program in PDF
01/23/2018 Diabetes Prevention Program in PDF
09/26/2017 SURS PowerPoint Slides in PDF
08/22/2017 Clinical Laboratory Improvement Amendment
07/25/2017 Medicaid Transportation FAQs
04/25/2017 2017 HMK Overview
02/28/2017 Telemedicine PowerPoint Slides in PDF
10/25/2016 Optometry Presentation PowerPoint Slides in PDF
Montana Medicaid strives to improve billing capacity within Tribal and Indian Health Service clinics. DPHHS is committed to improving the health of the Indian population in Montana.
For Tribal or Indian Health Service billing questions contact:
The IHS/Tribal/Urban Program Officer, (406) 444-1292 or Elizabeth.Wisner-Kinsey@mt.gov
Tribal/IHS Meeting Information
11/19/2024 Agenda
10/15/2024 Agenda
09/17/2024 Agenda
07/16/2024 Agenda
06/18/2024 Agenda
04/16/2024 Agenda
02/20/2024 Agenda
09/19/2023 Agenda
08/15/2023 Agenda
06/20/2023 Agenda
05/01/2023 NA
04/18/2023 Agenda
03/21/2023 Agenda
02/21/2023 Agenda
01/17/2023 Agenda
11/15/2022 Agenda
09/20/2022 Agenda
08/16/2022 Agenda
06/21/2022 Agenda
05/24/2022 Agenda
04/19/2022 Agenda
03/15/2022 Agenda