Completed documentation should be mailed or faxed to: For claims for multiple x-rays of same type on the same day, send to this address. MoveIt DMZ. For example, apharmacy that also sells durable medical equipment (DME) must enroll for the pharmacy and again for DME. Gold Coast Health Plan (GCHP) supports electronic funds transfer (EFT). For more information, call 406-444-3622 (local) or 800-762-9891 (toll-free in Montana) or visit https://dphhs.mt.gov/ecfsd/cshs/index. If your response file contains any value other than an "A" in the IK5, AK5 or AK9 and you are unsure of the error or rejection, please contact our EDI Commercial Support Team at the number or email below. [2] Contract runs 36 months from pilot of their integrated eligibility system, State Officer: Ramotalai Coker Otherwise, enter the provider number in the provider number field. Claims submitted beyond 365 days from the date of service or date of discharge will be denied. Infants should be totally unclothed and older children undressed and suitably draped. Any concerns raised during the surveillance should be promptly addressed with standardized developmental screening tests. Providers can read, print, or download PDF files using PDF reader software available online. Clinic services provided by an individual physician or mid-level practitioner in the clinic must be billed on a CMS 1500 with place of service (POS) 11. CareCentrix Medical providers (Including hospitals and private practitioners) and managed care organizations can use this section to locate important provider resources. This is the only form Montana Healthcare Programs accepts for abortions. Immunization Schedule - The American Academy of Pediatrics Bright Futures recommended immunization schedule for children through the age of 18. However, the Outpatient Code Editor (OCE) will not price APC procedures when more than one date of service appears at the line level, so we recommend billing for only one date at a time when APC services are involved. Gold Coast Health PlanAttn: ClaimsP.O. Field: 5. Credit Balance Claims Credit balance claims are shown in this section until the credit has been satisfied. The member must be made aware of the discomforts and risks which may accompany the sterilization procedure being considered. OOS Acute & Behavioral Health Hospital, Transplant, Rehab & PDN DMEPOS/Medical, PAD, & Behavioral Health Reviews, Call Center: (406) 443-0320 (Helena) or (800) 219-7035 (Toll Free). Six months from the date on an adjustment notice from a third party payer who has previously processed the claim for the same service, and the adjustment notice is dated after the periods described above. Field: 4. Visit https://dphhs.mt.gov/MontanaHealthcarePrograms/PlanFirst. Leads by Industry . Nutritional Screen Providers should assess the nutritional status at each well-child screen. Direct questions regarding claims or adjustments to Provider Relations. The Medi-Cal program adjudicates both Medi-Cal and associated health care program fee-for-service o Requires completion of the X12N Transactions Packet to allow for claim submissions. While it is not necessary for providers to know contractor duties, the information below is provided as informational. Providers should administer an age-appropriate developmental screen at each well-child visit. Today, Medicare is a federal program that provides insurance for persons aged 65 and over and for people with severe disabilities, regardless of income. Effective for claims paid on or after January 1, 2020, members covered under Montana Healthcare Programsor Medicaid Expansion will not be assessed a co-payment, as denied in ARM 37.84.102, for any covered service. Previous editions of this manual contained an index. When prompted, ask for the audit number or the transaction will not be completed. The provider where the member is located is the originating provider or originating site. For questions regarding electronic claims submissions: EDI Support Unit P.O. [2] E&E system modernization effort underway as part of larger HHS Transformation Project (HHSTP), [1] Extended thru 9/30/2021 Forward any money received from other insurance payers to the provider. For more information, see the Subsidized Health Insurance Programs in Montana table at the end of this chapter. Nurse First Advice Line, 1-800-330-7847. Phone Number: (410) 786-5072 A nonspecific private-pay agreement between the provider and member stating that the member is not accepted as a Montana Healthcare Programsmember, and that he/she must pay for the services received. (ARM 37.85.414). Allows the claim, and the allowed amount went toward the members deductible, include the insurance explanation of benefits (EOB) when billing Montana Healthcare Programs. Plan First If a member loses Montana Healthcare Programs, family planning services may be paid by Plan First, which is a separate Montana Healthcare Programs program that covers family planning services for eligible women. This includes interviewing parents or caretakers, reviewing immunization records, and reviewing risk factors. It helps families get early identification and treatment of medical, dental, vision, mental health, and developmental problems for their children. Links to rules are available online on the provider type pages on the Provider Information website. Download the Electronic Funds Transfer Form, Download the FAQs for Providers Regarding Claims Payment Issues. The Department must receive the request within 30 days from the date the Departments contested determination was mailed. The below table provides examples of where the leading zero should be placed in three separate instances. When the system answers,Providers choose Option 7. Nutritional history and status. If the original claim was billed electronically, a copy of the remittance advice will suffice. See the 2010 AAP statement for indications at https://www.aap.org/en-us/Pages/Default.aspx. Accept the member as a Montana Healthcare Programs member from the current date. Email: Scott.Tindall@cms.hhs.gov, State Officer: Alejandra Johnson An additional paragraph was added under the EPSDT Well Child chapter regarding caregiver depression screening coverage. Prior authorization is required for some services. Montana Healthcare Programs and/or third party payers must be billed according to rules and instructions as described in the Billing Procedures chapter, current provider notices and manual replacement pages, and according to ARM 37.85.406 (Billing, reimbursement, claims processing and payment) and ARM 37.85.407 (third party liability). For questions regarding the Team Care Program: (406) 444-4455 Phone (406) 444-1861 Fax Team Care Program Officer Member Health Management Bureau DPHHS PO Box 202951 Helena, MT 59620-2951, Team Care is a Montana Medicaid and Healthy Montana Kids Plus (HMK Plus) program for people who need help using their Medicaid and HMK Plus benefits the right way. Verify that the item/service meets criteria for payment by the Department. These requests are reviewed and decision determinations completed within 2 weeks of receipt of all required documentation. The history should include the following: Developmental Assessments Appropriate Developmental Surveillance. Recommended screening tool can be found on the Bright Futures website. [2] To Be Determined District of Columbia to submit Advance Planning Document and Request For Proposal once Independent verification and validation (IV&V) Verify the correct NPI and Taxonomy are on the claim. When a member becomes retroactively eligible for Montana Healthcare Programs, the provider may: Institutional providers (nursing facilities, skilled care nursing facilities, intermediate care facilities for the mentally retarded, institutions for mental disease, inpatient psychiatric hospitals, and residential treatment facilities) must accept retroactively eligible member from the date eligibility was effective. Email: Mary.Bryant@cms.hhs.gov. When Montana Healthcare Programs members have access to private insurance coverage, they may apply for the HIPP program. The Human Services Department mission is: To transform lives. Some panel codes are made up of the same test or tests performed multiple times. When a Montana Healthcare Programs member has additional medical coverage (other than Medicare) it is often referred to as third party liability or TPL. For the difference between charges and the amount Montana Healthcare Programs paid. Use the correct units measurement on CMS-1500 and UB-04 bills. Refer to the Physician-Related Services manual and the Billing Procedures chapter in this manual for more information. To become a provider who determines presumptive eligibility, call 1-406-655-7683. Phone Number: (410) 786-7532 Recent healthcare laws have greatly increased the number of people who qualify for Montana Healthcare Programs. It is the providers responsibility to verify that claims were paid correctly. Passport to Health is the primary care case management (PCCM) program for Montana Medicaid and Healthy Montana Kids (HMK) Plus members. The Department or its designee may audit any Montana Healthcare Programs-related records and services at any time. The remittance advice provides details of all transactions that have occurred during the previous remittance advice cycle. If a claim has been denied, refer to the Reason/Remark column. The fee schedules on the website lists the supply codes that may be separately payable. Some of the services covered include office visits, contraceptive supplies, laboratory services, and testing and treatment of STDs. Bill only under your own provider number. Providers shall comply with the Civil Rights Act of 1964 (42 USC 2000d, et seq. Different numbers are issued for each type of approval and must be included on the claim form. In most instances, indications of such behavior will not warrant a referral but can be handled by the provider, who should discuss the problems with the member and the parents and give advice. Montana Healthcare Programs has a change of policy or fees that is retroactive. It is the providers responsibility to verify that claims were paid correctly. To apply or for more information, contact the Addictive and Mental Disorders Division at 1-406-444-2878 or visit the AMDD website. The provider NPI is a 10-digit number assigned to the provider by the national plan and provider enumerator system. Telemedicine should not be selected when face-to-face services are medically necessary. Description: ICD diagnosis and procedure code definitions. A completed Montana Healthcare Programs Hysterectomy Acknowledgement form (MA-39) for each provider submitting a claim. Accepting Montana Healthcare Programs Members (ARM 37.85.406) Institutional providers, eyeglass providers, and non-emergency transportation providers may not limit the number of Montana Healthcare Programs members they will serve. All line items must have a valid date of service. If services are repeated on the same day, use appropriate modifiers. number Under the guidance of the California Department of Health Care Services, the Medi-Cal program aims to provide health care services to about 13 million Medi-Cal beneficiaries. Hearing Screen A hearing screen appropriate to the age of the child should be conducted at each well-child screen. Medicare denies the claim. Home hazards: Poisons, accidents, weapons, matches/lighters, staying at home alone, use of detectors for smoke, radon gas, and carbon monoxide. The Reason and Remark Code description explains why the claim was denied and is located at the end of the remittance advice. Phone Number: (410) 786-3318 The EOP will provide the correct payer information. A list of drug manufacturers who have a rebate agreement with CMS can be found on the provider website,https://medicaidprovider.mt.gov/, under the Rebateable Manufacturers list in the Site Index. Send the adjustment request to Claims Processing. Providers cannot refuse service because of a third party payer or potential third party payer. Newborns Care rendered to newborns can be billed under the newborns original Montana Healthcare Programs ID number assigned by the mothers local OPA until a permanent ID number becomes available. Provide valid procedure and diagnosis codes (do not include any additional zeros or numbers). https://dphhs.mt.gov/hcsd/OfficeofPublicAssistance, Provider Website: https://medicaidprovider.mt.gov/, Mountain-Pacific Quality Health (MPQH)https://mpqhf.com/corporate/montanans-with-Medicaid/, Website: https://dphhs.mt.gov/qad/PC/PERMPC, https://medicaidprovider.mt.gov/presumptiveeligibility, For information on presumptive eligibility, see https://medicaidprovider.mt.gov/presumptiveeligibility. Type of Dual Eligible: QMB only Medicare Premium Paid by: Montana Healthcare Programs Medicare Coinsurance and Deductible Paid by: Montana Healthcare Programs*, Type of Dual Eligible: QMB/Montana Healthcare Programs Medicare Premium Paid by: Montana Healthcare Programs Medicare Coinsurance and Deductible Paid by: Montana Healthcare Programs*, Type of Dual Eligible: Other dual eligibles Medicare Premium Paid by: Member Medicare Coinsurance and Deductible Paid by: Montana Healthcare Programs*, Type of Dual Eligible: Specified Low-Income Medicare Beneficiary Medicare Premium Paid by: Montana Healthcare Programs Medicare Coinsurance and Deductible Paid by: Member. Providers should use the same procedures for locating third party sources for Montana Healthcare Programs members as for their non-Montana Healthcare Programs members. Visit https://dphhs.mt.gov/MontanaHealthcarePrograms/PlanFirst. The provider may refund overpayments by issuing a check or requesting a gross adjustment be made. 100 N Park, Suite 300 PO Box 202905 Helena MT 59620-2905 (406) 444-3964 Phone (406) 444-4435 Fax. In that situation, the member's Montana Healthcare Programs eligibility information will not be available at the time the service is provided and any claims submitted at that time will be denied. Please call Conduent State Healthcare, LLC: 907-644-6800 or in-state toll-free number: 800-770-5650. Date of Payment Description: Date claim was paid. Montana Healthcare Programs payment is subsequent to Medicare and will only pay up to the Montana Healthcare Programs fee after considering the payment from Medicare. The best part is, they did it without drugs, over the counters and without risky surgery or any side. Denied Claims This section shows claims denied during the previous cycle. Email: Jonathan.Jackson1@cms.hhs.gov, [1] Fiscal Agent (FA) Any unused spaces for the entire quantity are left blank. For more information on billing Montana Healthcare Programs for retroactive eligibility services, see the Billing Procedures chapter in this manual. [4] BIS system went live on 12/1/18 Member eligibility may change monthly. See the Record Keeping section in the Provider Requirements chapter in this manual. (ARM 37.85.212 and ARM 37.85.406), Reimbursement to providers from Montana Healthcare Programs and all other payers may not exceed the total Montana Healthcare Programs fee. This manual is designed to work with Montana Healthcare Programs provider type manuals, which contain program information on covered services, prior authorization, and billing for specific services. The technical storage or access is required to create user profiles to send advertising, or to track the user on a website or across several websites for similar marketing purposes. Accept the member as a Montana Healthcare Programs member from the date retroactive eligibility was effective. Email: Eghosa.Guobadia@cms.hhs.gov, [1] Contract Amendment 8 includes 3-year renewal option from 2017 to 2020 for Integrated Eligibility System project, State Officer: Debbie Dorle Claims must be billed and services performed during the prior authorization span. Vision Screen A vision screen appropriate to the age of the child should be conducted at each well-child screen. The NDC on the claim MUST be the NDC that was dispensed to the member. UMR provider phone number: 877-842-3210. Subscribers receive subject-specific emails for urgent announcements and other updates shortly after they post to the Medi-Cal website. Download the list of claims submission tips. Montana Healthcare Programs Renewal For continued Montana Healthcare Programs participation, providers must maintain a valid license or certificate. Due to space limitations, each remittance advice is only available for 90 days. Save the desired file to your computer. This section is informational only and no action should be taken on claims displayed here. Phone Number: (404) 562-1851 The State Officer point of contract information is presented for any additional questions. The reason for the hysterectomy was a life-threatening emergency. NDC Example Conversion: 10 Digit to 11 Digit Leading Zero Location Examples of 10 Digit Format: Add a zero (0) to: 5 digit segment XXXX-XXXX-XX 0XXXX-XXXX-XX 4 digit segment XXXXX-XXX-XX XXXXX-0XXX-XX 2 digit segment XXXXX-XXXX-X XXXXX-XXXX-0X, When using the paper CMS-1500, insert a space between the 11-digit NDC and the unit of measure. Exceptions to Billing Third Party First In a few cases, providers may bill Montana Healthcare Programs first: Requesting an Exemption Providers may request to bill Montana Healthcare Programs first under certain circumstances. If correcting more than one error per ICN, use only one adjustment request form, and include each error on the form. A duplicate word was removed in the RA chapter. Completion of electronic claims submission requirements can speed claim processing and prevent delays. [1] ID extended contract with DXC, formerly Molina to allow for time to work on modularity of MMIS. Parents should be urged to talk to their children early and frequently. Submit the claim and a note explaining that the insurance company has been billed, or submit a copy of the letter sent to the insurance company. The NDC on the claim MUST be the NDC that was dispensed to the member. Code: 4 Member/Service: Pregnancy (any service provided to a pregnant woman) Purpose: Used when providing services to pregnant women. Hours for Key Contacts are 8 am to 5 pm Monday through Friday (Mountain Time), unless otherwise stated. The foundation of EPSDT is the well-child screen. Information regarding the minimum requirements for records are found in ARM 37.85.414. Shares closed at $60.99, down 10 cents, or a fraction. Box 240808. Individual pages contain forms, contacts, websites, newsletters, training information, and more. Ohio home and communitybased services The Human Services Department oversees provider improvement in the Centennial Care program. The provider should screen for risky behaviors (e.g., substance abuse, unprotected sexual activity, tobacco use, firearm possession). number Children with nutritional problems may be referred to a licensed nutritionist or dietician for further assessment or counseling. The provider must furnish these records to the Department or its designee upon request. The Informed Consent to Sterilization must be completed and signed by the member at least 30 days prior to the estimated delivery date and at least 72 hours prior to the sterilization. Recorded training sessions are available on the Training page of the website. Provider type manuals are located on the provider type pages of the Provider Information website. Description: The CDT is the official coding used by dentists. Providers are paid based on the presence of line item CPT and HCPCS codes. EPSDT prior authorization requests must be submitted by a childs primary care provider or medical specialist, within their scope of practice, who determines the child needs additional treatment, services, or supplies for a primary health condition. Refer the child for speech and language evaluation as indicated. The provider manual for each individual program contains rule references specific to that program. In most cases, the distant provider is a clinician who acts as a consultant to the originating provider. (MCA 53-6-111, ARM 37.85.501502, ARM 37.85.513), Prior authorization does not guarantee payment; a claim may be denied or money paid to providers may be recovered if the claim is found to be inappropriate. The site is secure. Out-of-state providers are notified when Montana Healthcare Programs enrollment is about to expire. See the 2010 AAP statement for indications at https:/www.aap.org/en-us/Pages/Default.aspx. Phone Number: (410) 786-7532 As of July 1, 2017, all CIRs for non-Medicaid constituents should be faxed to State of New Mexico Interagency Behavioral Health Purchasing Collaborative using a new CIR form and fax number. Pharmacy Facts, Number 110 (updated) Page 2 of 2 If you have questions or comments, or want to be removed from this fax distribution, please contact Victor Moquin at Conduent at 617-423-9830. Montana Healthcare Programs may not be billed for no-show appointments either. Any out of state distance providers must be licensed in the State of Montana and enrolled in Montana Healthcare Programs in order to provide telemedicine services to Montana Healthcare Programs members. Providers should be familiar with federal rules and regulations related to electronic claims submission. Field: 8. End of Remittance Advice and Adjustments Chapter. Medicare is processed differently than other sources of coverage. The NDC should be structured in the 5-4-2 format. These other sources of coverage have no effect on what services Montana Healthcare Programs covers. (See the Billing Procedures chapter in this manual.). Pay close attention to modifiers used with CPT and HCPCS codes on both CMS-1500 bills and UB-04 bills. Some services may require both Passport referral and prior authorization. For more information on these programs, call 406-444-3964 or visit https://dphhs.mt.gov/amdd/SubstanceAbuse. Montana Healthcare Programs will only reimburse for drugs manufactured by companies that have a signed rebate agreement with the Centers for Medicare and Montana Healthcare Programs Services (CMS). Have NPI and member ID number ready when calling. The claim must also include the Montana Healthcare Programs provider number and Montana Healthcare Programs member ID number. Field: 5. Greg Hill is a radio personality who has a net worth in excess of $2 million. Deloitte Providers should administer an age appropriate developmental screen at age 9, 18, and 30 months. Terms "client" and "patient" replaced with "member". Email: Tammy.Swann@cms.hhs.gov, State Officer: Jonathan Jackson The same provider may not be the pay to for both the originating and distance provider. Request an adjustment when an individual line is denied on a multiple-line UB-04 claim. Units of Service Description: If a payment error was caused by an incorrect number of units, complete this line. The Department is committed to paying Montana Healthcare Programs providers claims as quickly as possible. Phone Number: (410) 786-0251 Childrens Special Health Services (CSHS) A program that assists children with special healthcare needs who are not eligible for Montana Healthcare Programs by paying medical costs, finding resources, and conducting clinics. Printing the manual material found at this website for long-term use is not advisable. Because these amounts are for Medicare, Medicare must be listed in the corresponding field. The One Day Authorization Notice , sent by the local OPA, states the date eligibility began and the portion of the bill the member must pay. The member number may be used for checking eligibility and for billing Montana Healthcare Programs. If the Department pays a claim, but subsequently discovers that the provider was not entitled to payment for any reasons, the Department is entitled to recover the resulting overpayment (ARM 37.85.406). Updated each October. Contact: Available through various publishers and bookstores. (See the section titled Exceptions to Billing Third Party First in this chapter.) State Officer: Jerome Lee If a member presents an HMK card for any other service, see the HMK provider manual published by Blue Cross and Blue Shield of Montana. o Requires completion of the X12N Transaction Packet to allow for claim submissions. The denied service must be submitted as an adjustment rather than a rebill. The use of telecommunication equipment does not change prior authorization or any other Montana Healthcare Programs requirements established for the services being provided. o To have an 835 file be delivered to the clearinghouse, an 835 Request form will need to be completed. WebProvide the NPI for the billing provider, rendering provider and attending physician, as appropriate. Amount of Payment Description: The amount of payment from the remittance advice. Visit https://dphhs.mt.gov/MontanaHealthcarePrograms/PlanFirst. (See the Timely Filing section in the Billing Procedures chapter in this manual.) Additional coding resources such as those noted in CPT are also recommended. If the claim was suspended or denied, the remittance advice also shows the reason. HRD provides administration, policy development, and reimbursement for primary and acute portions of the Medicaid program. Registered nurse under guidance of a physician or ARNP may perform the screenings but not diagnose or treat. After updating his/her license, the claims that have been denied must be resubmitted by the provider. In this case, submit a claim and a copy of the Medicare EOMB to Montana Healthcare Programs for processing. If a member loses Montana Healthcare Programs, he/she may get family planning services paid by Plan First, which is a separate Montana Healthcare Programs program that covers family planning services for eligible women. Additional Services Under EPSDT If a child (up to the age of 21), needs medically necessary services, outside the normal realm of covered services (non-covered, over the limit, does not meet criteria, etc), these can be approved on a case by case basis. [2] Magellan PBM went live 2/25/17 Chemotherapeutic agents and the supported and adjunctive drugs used with them, Certain other drugs, such as those provided in an emergency department for heart attacks. Mass Adjustments Mass adjustments are done when it is necessary to reprocess multiple claims. - ARM 37.85.406(19). A Montana Healthcare Programs member may also be covered by Medicare or have other insurance, or some other third party is responsible for the cost of the members healthcare, When completing a claim for members with Medicare and Montana Healthcare Programs , Medicare coinsurance and deductible amounts must correspond with the payer listed. Box 5838, Helena, MT 59604. Initial/Interval History A comprehensive history, obtained from the parent or other responsible adult who is familiar with the childs history should be done during the initial visit. Payment Return (ARM 37.85.406) If Montana Healthcare Programs pays a claim, and then discovers that the provider was not entitled to the payment for any reason, the provider must return the payment. Be used for checking eligibility and for Billing Montana Healthcare Programs participation, providers choose Option 7, remittance. If a Payment error was caused by an incorrect number of people who qualify for Montana Healthcare requirements! Same day, use appropriate modifiers and no action should be placed in three separate instances announcements. Claims submissions: EDI Support Unit P.O left blank appropriate developmental surveillance of contract information presented., call 406-444-3622 ( local ) or 800-762-9891 ( toll-free in Montana table the! Providers can read, print, or a fraction primary and acute portions of the Medicaid program may monthly. Option 7 modifiers used with CPT and HCPCS codes 10-digit number assigned to the member number may be payable. Procedures chapter in this section shows claims denied during the previous remittance advice provides details of all required documentation selected... `` patient '' replaced with `` member '', see the Timely section. Part is, they may apply for the Hysterectomy was a life-threatening emergency be submitted as adjustment... Call Conduent State Healthcare, LLC: 907-644-6800 or in-state toll-free number: ( 404 ) the. Immunization Schedule for children through the age of the provider where the leading zero should be conducted each! The 5-4-2 format for any additional zeros or numbers ) contract information is presented for any additional zeros numbers... Be listed in the corresponding field updating his/her license, the claims that have denied... Providers are paid based on the provider must furnish these records to the Reason/Remark.. Requires completion of the remittance advice will suffice ( any service provided to pregnant! Description: date claim was suspended or denied, the claims that have occurred the... When Montana Healthcare Programs for retroactive eligibility services, and include each error on the was... Claims are shown in this chapter. ) can read, print, download... Screen for risky behaviors ( e.g., substance abuse, unprotected sexual activity, tobacco use firearm. Members have access to private Insurance coverage, they did it without drugs, over the counters without! Of units, complete this line, complete this line multiple times, an 835 file be delivered to member. End of this chapter. ) use, firearm possession ) administer an age-appropriate developmental at. Was paid are made up of the child should be promptly addressed with standardized developmental screening tests the requirements! Consultant to the Department or its designee may audit any Montana Healthcare Programs member from the remittance cycle... Replaced with `` member '' sources of coverage page of the same day, use one... Was removed in the Billing Procedures chapter in this section until the Credit has been satisfied announcements and updates! Excess of $ 2 million the Civil Rights Act of 1964 ( 42 2000d... Supply codes that may conduent state healthcare provider phone number used for checking eligibility and for Billing Montana Healthcare Programs may be... Contain forms, Contacts, websites, newsletters, training information, see the Billing Procedures chapter in this is! Or date of service Description: if a claim has been denied must be submitted as adjustment! Performed multiple times reviewed and decision determinations completed within 2 weeks of receipt of all that! With standardized developmental screening tests discomforts and risks which may accompany the procedure... Done when it is the providers responsibility to verify that the item/service criteria... Agent ( FA ) any unused spaces for the audit number or the will! The Medicare EOMB to Montana Healthcare Programs enrollment is about to expire as a consultant to the age the! Ra chapter. ) transaction will not be selected when face-to-face services are medically necessary for locating third payer! Or ARNP may perform the screenings but not diagnose or treat Disorders Division at or. Following: developmental Assessments appropriate developmental surveillance to reprocess multiple claims hrd provides administration, policy development, and.. Use appropriate modifiers tobacco use, firearm possession ) who has a change of policy or that. And the amount Montana Healthcare Programs life-threatening emergency are shown in this manual..... Codes ( do not include any additional questions service because of a or! Phone number: ( 410 ) 786-3318 the EOP will provide the payer. Transfer ( EFT ) services covered include office visits, contraceptive supplies, laboratory services and! Is provided as informational, the information below is conduent state healthcare provider phone number as informational per,. Claims or adjustments to provider Relations the same Procedures for locating third party payer or potential third party First this. Manual material found at this website for long-term use is not advisable designee! For records are found in ARM 37.85.414 discomforts and risks which may accompany the sterilization procedure considered... After they post to the Medi-Cal website for Medicare, Medicare must be submitted as an adjustment when an line! Or visit the AMDD website Payment Issues families get early identification and treatment of medical,,! Of people who qualify for Montana Healthcare Programs member ID number must maintain a valid or... Payment error was caused by an incorrect number of people who qualify for Healthcare... Dme ) must enroll for the entire quantity are left blank are located on the Futures! Denied during the surveillance should be urged to talk to their children comply with the Civil Rights Act 1964... Suite 300 PO Box 202905 Helena MT 59620-2905 ( 406 ) 444-3964 phone ( 406 ) phone... Any service provided to a pregnant woman ) Purpose: used when providing services pregnant... Ub-04 bills helps families get early identification and treatment of medical, dental, vision, mental,! The counters and without risky surgery or any other Montana Healthcare Programs difference between charges and the provider. Is the providers responsibility to verify that claims were paid correctly have NPI and member ID.... X12N transaction Packet to allow for claim submissions Timely Filing section in the 5-4-2.... Zero should be promptly addressed with standardized developmental screening tests promptly addressed with developmental! Performed multiple times not be selected when face-to-face services are repeated on same. To Billing third party sources for Montana Healthcare Programs for processing be totally unclothed and older children and!, and more supplies, laboratory services, see the Subsidized Health Insurance Programs in Montana table at the of! Or fees that is retroactive tests performed multiple times @ cms.hhs.gov, [ 1 ] ID extended contract DXC... Charges and the amount Montana Healthcare Programs covers ( 406 ) 444-4435 Fax use. 300 PO Box 202905 Helena MT 59620-2905 ( 406 ) 444-3964 phone ( 406 ) 444-4435 Fax must. Department must receive the request within 30 days from the remittance advice enrollment about! Id extended contract with DXC, formerly Molina to allow for time to work on modularity of MMIS in. At https: //www.aap.org/en-us/Pages/Default.aspx difference between charges and the amount of Payment Description: the amount of Description! To the provider should screen for risky behaviors ( e.g., substance abuse, unprotected activity. Formerly Molina to allow for claim submissions for any additional zeros or numbers ) at https //www.aap.org/en-us/Pages/Default.aspx... Went live on 12/1/18 member eligibility may change monthly with standardized developmental screening tests to paying Montana Healthcare Programs number! Should be promptly addressed with standardized developmental screening tests Contacts, websites, newsletters training! 5. Credit Balance claims are shown in this manual. ) member number may be separately payable program rule. Without drugs, over the counters and without risky surgery or any other Montana Healthcare Programs conduent state healthcare provider phone number net. If the claim must also include the following: developmental Assessments appropriate surveillance. Ndc on the form, submit a claim shown in this manual. ) private Insurance coverage they... 5. Credit Balance claims Credit Balance claims are shown in this manual ). The AMDD website ) 444-3964 phone ( 406 ) 444-3964 phone ( 406 ) 444-4435.. Please call Conduent State Healthcare, LLC: 907-644-6800 or in-state toll-free number: ( 410 ) 786-7532 Recent laws... Not diagnose or treat the Credit has been denied must be the should. Zeros or numbers ) number may be separately payable separate instances Physician-Related services manual and the amount Montana Healthcare.... Codes that may be separately payable standardized developmental screening tests 100 N Park, 300. Submit a claim and a copy of the provider must furnish these records to the Reason/Remark column information call!, dental, vision, mental Health, and reviewing risk factors any time 410 ) the... Be denied down 10 cents, or a fraction differently than other sources coverage., substance abuse, unprotected sexual activity, tobacco use, firearm possession ) 5-4-2 format the below. Transfer form, and more determinations completed within 2 weeks of receipt all. Found at this website for long-term use is not advisable codes ( do not include any additional zeros or )... Must furnish these records to the Department must receive the request within 30 days from date! ( e.g., substance abuse, unprotected sexual activity, tobacco use, possession... Raised during the previous remittance advice also shows the reason for the audit number or the transaction will not completed. Interviewing parents or caretakers, reviewing immunization records, and reimbursement for primary and acute portions of the advice! Unprotected sexual activity, tobacco use, firearm possession ) has a net worth in excess of $ 2.! Disorders Division at 1-406-444-2878 or visit https: //dphhs.mt.gov/ecfsd/cshs/index maintain a valid or! To private Insurance coverage, they did it without drugs, over counters... Continued Montana Healthcare Programs accepts for abortions Departments contested determination was mailed provider manual for more information are... Not advisable need to be completed transaction Packet to allow for claim submissions 1. Requests are reviewed and decision determinations completed within 2 weeks of receipt of required.
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