Claim Instructions

 

New Provider Services Portal for Enrollment, Maintenance and Claims Entry available 12/13/2021.

Montana Healthcare Programs is excited to introduce a new Provider Services Module. Beginning December 13, 2021, you will notice a change to the online enrollment links. All providers seeking to enroll with Montana Healthcare Programs will be directed to the new MPATH online application offering a more efficient way to enroll, update information and easily submit claims!

MPATH Claims Entry Solution - The claims entry solution is an online tool allowing providers to manually enter claims. Available options include:

  • Claim form templates - The system allows users to create and save templates for common claim submissions. No need to start from scratch every time.
  • Diagnosis and Procedure code look up - The system has code look up features to assist with entering correct information.
  • Ability to submit multiple claim types - including Professional, Facility and Dental claims.
  • Great alternative to WinASAP5010 - The claims entry solution is a free, simple to use and providers can enter claims without converting and uploading files.
  • Electronic Claim Adjustments - Paper adjustment forms are no longer required. The provider service module allows for online claim adjustments.

 

Provider Services Portal

 

There are two ways to submit claims to the Montana Healthcare Programs: Electronic and paper.  Electronic claims are processed an average of 14 days faster than paper claims. Paper claims submitted via mail are processed an average of 12 days faster than paper claims submitted by fax. The information below is intended to support claim submission in both formats. 

Whether you submit one claim a month or hundreds, any provider can benefit from switching from paper to electronic billing. Whether by using the free Provider Services Portal or by using a clearinghouse to submit claims, electronic billing is faster, more accurate, and more secure.

See Electronic Submission Setup below to begin the process.

For information about HIPAA 5010,visit the HIPAA5010 page on this website

Follow the steps below to submit your Medicaid claims electronically.

STEP 1

Download the electronic billing enrollment forms and instructions below. Complete and submit the forms to the address/fax number listed on the EDI enrollment form.

Clearinghouses or Billing Agents

EDI Submitter Enrollment Packet for X12N Transaction
All forms must be completed. To print individual sections, access the links below.

Individual Providers

EDI Submitter Enrollment Packet for X12N Transaction
Providers may omit sections 4a, 7b, and 8 Of the EDI Provider Enrollment Form. To print individual sections, access the links below.

STEP 2

Follow the steps in chapter 2 of the Provider Services Portal User Guide to register and set up your user access for the Provider Services Portal.

  • You must have completed the enrollment packet and received your welcome letter before using the Provider Services Portal for claims.

  • For technical support, please contact Provider Relations at (800) 624-3958.

STEP 3

Login to the Provider Services Portal.

Under myMenu, without clicking, place your curser on Claims.

A side menu with submission options will appear.

Select the claims submission option you wish to use to submit claims using the free Provider Services Portal.

To bill claims electronically, a provider must enroll with EDI Solutions following the steps in the Electronic Submission Setup tab. 

The Provider Services Portal is a web-based program hosted by MPATH and allows providers to submit directly to Medicaid without a software download.

If you have questions regarding the Provider Services Portal, please contact Provider Relations at (800) 624-3958.

Provider Services Portal User Guide

Instructions for Billing Electronically

Paper Claim Instructions

Providers bill using their NPI and their taxonomy code or their atypical provider ID number.

Instructions for Completing the CMS-1500

CMS-1500 (02/12) As of April 1, 2014, this is the accepted version of the CMS-1500.

Instructions for Completing the UB-04

UB-04 Using NPI and Taxonomy

Instructions for Completing the 2019 Dental Claim Form

Sample ADA Dental 2019 Claim Form 10/2021

Electronic Claim Adjustments

Electronic Adjustments are now accepted by Montana Medicaid. There will be 2 options for submitting an electronic adjustment, depending on how the claim was originally submitted.

Acceptable frequency codes:

1 Indicates the claim is an original claim.
7 Indicates the new claim is a replacement or corrected claim – the information present on this claim represents a complete replacement of the previously issued claim.
8 Indicates the claim is a voided/canceled claim

Instructions for a Clearing House or Other Direct Submission Software

Create a new claim with the corrected information. If you are voiding the claim, claim information must match original claim.

All claim types

Loop 2300 - (CLM05-3) is the Claim Frequency Code. Enter 7 or 8.
REF*F8* - Enter the original ICN.

MPATH Claims Solutions

Create a new claim with the corrected information. If you are voiding the claim, claim information must match original claim.

Professional Claims (CMS-1500) & Dental Claims

Answer YES, to the first question at the bottom of the claim entry screen. The next two fields are now visible.

Select either Replacement of prior claim or Void of prior claim from the Medicaid Resubmission drop down.

Enter the Paid ICN of the claim being adjusted in the Original Reference Number field.

Institutional Claims (UB-04)

When recreating the claim, change the last digit of the Type of Bill code to either 7 for replacement or 8 for void.

The Original Reference Number filed is now visible. Enter the Paid ICN of the claim being adjusted in the Original Reference Number field.

MPATH Provider Services Portal Claims Training Presentation

This is a portion of the January 2022 Provider Services Module training presentation. To view the entire training presentation, please see the Training Page.

Montana Medicaid reimburses only for drugs that are manufactured by companies that have a signed rebate agreement with CMS. An updated list of these manufacturers has been posted on the Site Index under Rebateable Manufacturers.

To determine if a manufacturer has signed a rebate agreement, check the first five digits of the National Drug Code (NDC) against the list. If there is no match, the drug is not reimbursable.

The list will be updated quarterly, so check regularly to assure coverage.

In addition, the valid NDC must be recorded on the claim (no spaces, no punctuation) as an 11-digit series of numbers. Claims will be denied for drugs billed without a valid 11-digit NDC. Providers also must be careful when entering the NDC quantity (the administered amount).