Discrepancy in denial reason codes:
The denial reason codes on eSors may be different than what is made available on the web portal or in 835 responses. Our technicians are working on the issue and will provide an update when more information is available. (posted 2/19/2020 8:45am)
Provider Rate Mass Adjustment
The Department is in the process of adjusting claims impacted by provider rate increases effective July 1, 2018 based on the adoption of MAR 37-863. The Department will handle the adjustment process for impacted claims with a date of service on or after July 1, 2018. Below is a link to the mass adjustment schedule for these claims, by provider type. Modifications to the schedule, if necessary, will be posted to the site as appropriate
The Current Mass Adjustment Schedule may be found at
https://medicaidprovider.mt.gov/Portals/68/docs/current/massadjustmentannouncement.pdf.
No action is required by providers who billed usual and customary charges. Home and Community-Based Services, and Personal Assistance/Community First Choice providers will follow a separate adjustment process and are not included in this schedule.
Medicaid Fee Schedules
In accordance with Montana Administrative Register 37-863, Montana Healthcare Programs has updated provider rates, effective July 1, 2018. The Department will be finalizing the adjustment process for claims billed before October 22, 2018 for claims with a date of service on or after July 1, 2018. The Department will be issuing information pertinent to the rate changes and subsequent claim adjustments. It will be important for providers to review future notices for more detailed information on the Montana Healthcare Programs Provider Information Website under the menu option, Resources by Provider Type. No action on your part is needed at this time.
New Web Port Password Reset Process
Effective 10/3, you will no longer need to contact Provider Relations via telephone for a web portal password reset.
A self-serve reset function in the portal will be available beginning Monday 10/3.
At that time all other Web Portal telephone inquiries will be directed to the EDI option 2.
Provider and Member Crime Victim Surveys
The University of Montana is asking for providers to complete an online survey an important study that is funded by the Office for Victims of Crime at the United States Department of Justice: “The Montana Crime Victim Legal Assistance Network Project” (CFDA #16. 826, Award # XV-BX-K011).
There is a specific section on the survey for healthcare providers.
Please take the survey.
The U of M is also asking that you print and post a flyer about a crime victim survey for your Medicaid members and other patients.
The flyer should be posted through May 27, 2017.
(posted 11/18/2016)
Bookmark http://www.medicaidprovider.mt.gov
Many providers navigate to http://www.medicaidprovider.mt.gov through old site addresses. All old addresses will be retired at the end of April 2016. Providers and billers are urged to make sure that they have bookmarked http://www.medicaidprovider.mt.gov and have deleted any older URLs. (PD03152016)
For more information visit the CMS website. To apply, fill out an application.
Inappropriate Denials for Physician Administered Drugs for Rebate Agreement Not in Place
During the last payment cycle, Provider Relations identified claims for Physician Administered Drugs that were denied inappropriately as not being covered because a rebate agreement with the manufacturer was not in place.
Provider Relations has identified and corrected the issue that caused these denials and will adjust claims that were not paid appropriately.
This adjustment will take place during the next few days, and these claims should be paid and appear on next week’s remittance advices. We apologize for the delay in payment. (PD12182015)
Electronic Funds Transfer (EFT) and Electronic Remittance Advice (ERA) Changes Final Update
This notice supersedes all written documentation regarding EFT and ERAs, including Claim Jumper articles, provider notices, and announcements posted on the Provider Information website.
All Montana Healthcare Programs providers, Medicaid/HMK Plus, CHIP/HMK, and Mental Health Services Plan (MHSP), will be moved to EFT (direct deposit) and ERA over the next two months.
In order to accomplish this transition, Provider Relations will eliminate both the paper remittance advice option and paper warrants/checks. Some providers were affected as early as December 1, 2014.
To avoid disruption in receiving remittance advices and payments, providers should initiate the change to EFT/ERA as soon as possible. All providers must be registered for the web portal and submit their paperwork to Provider Relations to be eligible for payment and receive applicable ERAs in 2015.
If you are enrolled in EFT, receive ERAs, completed a Trading Partner Agreement (TPA) and have already registered for the Montana Access to Health (MATH) web portal, you meet the requirements of the policy and no additional documentation is needed. Providers who currently receive paper checks and/or paper remittance advices must follow the process below to transition to EFT and ERAs.
Forms Needed
To sign up for EFT (direct deposit) and register for the web portal, providers need to complete the documents listed below and mail or fax them to Provider Relations. See the Provider Enrollment page for the needed documents.
Montana Medicaid Electronic Funds Transfer (EFT) & Electronic Remittance Advice (ERA) Authorization Agreement
Trading Partner Agreement
A letter/form on your financial institution's letterhead verifying legitimacy of the account. The letter/form must include the name and contact information of the bank representative, be signed by the bank representative, and verify the account type (checking or savings), financial institution routing number, and provider account number. Do not send voided checks or deposit slips.
EFT Instructions
To enroll in EFT, a provider must complete and sign the EFT & ERA Authorization Agreement and mail or fax the Agreement and the financial institution letter to provider Relations.
Upon receipt of the form, Provider Relations adds the EFT information to the provider’s profile. This process takes up to 10 business days. Once completed, the provider will get paid via EFT on the next payment cycle.
ERA Instructions
To receive ERAs, a provider must complete the Trading Partner Agreement (TPA) and register on the MATH web portal to view the ERAs.
1. The provider prints, completes, and signs the TPA. The provider
must include his/her NPI/API on the last page of the TPA.
2. The provider faxes or mails the TPA to Provider Relations.
Once Provider Relations receives the TPA,the process takes up to 10
business days.
3. Provider Relations mails the Welcome Letter to the provider. This letter
contains the credentials to register for the web portal
(user ID and password) and the provider's submitter ID.
4. Providers can then register online using the information
provided in the Welcome Letter. Click the Log in to
Montana Access to Health link at the top of this page.
You may also want to reference the web portal tutorials:
Web Portal Registration and Web Portal Navigation.
Upon registering, providers are notified via e-mail
that they must change their password and have
24 hours to do so.
5. Once registered, the provider must access Manage Users
and Update or Remove Users and grant yourself Security
Privileges following the instructions given. Providers must
log out and back in for the privileges to take effect.
6. To access a remittance advice (in PDF format), click on
Retrievals and View e!SOR Reports.
Mail or fax enrollment documents to Provider Relations:
Provider Relations
P.O. Box 4936
Helena, MT 59604
406.442.4402 Fax
Providers may also request an 835 ERA delivered to their clearinghouse.
Please contact your clearinghouse or software vendor to begin that process. (PDR11272015)
Important Information Regarding CMS-1500
As of April 1, 2014, the CMS-1500 (08/05) is no longer a valid form for the submission of professional claims. Providers must use the CMS-1500 (02/12) claim form for submission of Medicaid claims for payment.
See the Claim Jumper for information about billing with the 02/12 version and reference the guideline developed by the National Uniform Claim Committee at www.nucc.org. (PD04112014)
Retroactive Eligibility
Effective January 1, 2014, providers must use the Notice of Retroactive Eligibility (160-M) if a member has been determined retroactively eligible. The FA-455 and FA-454 are no longer accepted.
Providers should attach the Notice of Retroactive Eligibility (160-M) when submitting claims for retroactively eligible member for which the date of service is more than 12 months earlier than the date the claim is submitted. Claims submitted without the Form 160-M will not be paid.
Contact the member’s Office of Public Assistance to request the form. See http://www.dphhs.mt.gov/hcsd/OfficeofPublicAssistance.aspx. (PD042014)
NPI Required for Eligibility Verification
Providers must use their NPI/API when inquiring about member eligibility using FaxBack, the Voice Response system or the MATH web portal. If you have questions, call Provider Relations at 1.800.624.3958.
EDI Solutions Website Links Updated
The EDI Solutions website has changed. For Montana Medicaid, click on the EDI Solutions Clients tab and choose Montana Department of Public Health and Human Services.
WINASAP 5010 software can be found under the WINASAP tab. EDI enrollment information is available on the EDI Enrollment page. If you are having trouble finding information, contact Provider Relations 1.800.624.3958.