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Rule Chapter: 37.85
Chapter Title: GENERAL MEDICAID SERVICES
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37.85 : GENERAL MEDICAID SERVICES


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Rule No. Rule Title Latest
Version
Effective
Date
Subchapter 1
Montana Medicaid Provider Fee Schedules
37.85.104 EFFECTIVE DATES OF PROVIDER FEE SCHEDULES FOR MONTANA NON-MEDICAID SERVICES access file 7/1/2014
37.85.105 EFFECTIVE DATES, CONVERSION FACTORS, POLICY ADJUSTERS, AND COST-TO-CHARGE RATIOS OF MONTANA MEDICAID PROVIDER FEE SCHEDULES access file 7/1/2014
Subchapter 2
Miscellaneous
37.85.201 SELECTION OF PROVIDER access file 7/1/1999
Rules 37.85.202 and 37.85.203 reserved
37.85.204 RECIPIENT REQUIREMENTS, COST SHARING access file 11/15/2002
37.85.205 RECIPIENT RESTRICTION OF ACCESS TO MEDICAL SERVICES REP 7/23/2004
37.85.206 SERVICES PROVIDED access file 8/24/2012
37.85.207 SERVICES NOT PROVIDED BY THE MEDICAID PROGRAM access file 1/1/2013
Rules 37.85.208 through 37.85.211 reserved
37.85.212 RESOURCE-BASED RELATIVE VALUE SCALE (RBRVS) REIMBURSEMENT FOR SPECIFIED PROVIDER TYPES access file 7/1/2014
Rules 37.85.213 through 37.85.219 reserved
37.85.220 INDEPENDENT DIAGNOSTIC TESTING FACILITIES access file 1/1/2013
Subchapter 3
reserved
Subchapter 4
Provider Requirements
37.85.401 PROVIDER PARTICIPATION access file 3/11/1997
37.85.402 PROVIDER ENROLLMENT AND AGREEMENTS access file 3/11/1997
37.85.403 ICD CLINICAL MODIFICATION (CM) AND PROCEDURAL CODING SYSTEM (PCS) SERVICES access file 3/14/2014
Rules 37.85.404 and 37.85.405 reserved
37.85.406 BILLING, REIMBURSEMENT, CLAIMS PROCESSING, AND PAYMENT access file 1/1/2007
37.85.407 THIRD PARTY LIABILITY access file 3/11/1997
Rules 37.85.408 and 37.85.409 reserved
37.85.410 DETERMINATION OF MEDICAL NECESSITY access file 3/11/1997
37.85.411 PROVIDER RIGHTS access file 6/30/2000
37.85.412 INTERPRETATION OF RULES access file 4/1/2005
37.85.413 LIMITATIONS ON CODING ADVICE access file 4/1/2005
37.85.414 MAINTENANCE OF RECORDS AND AUDITING access file 4/1/2005
37.85.415 MEDICAL ASSISTANCE MEDICAID PAYMENT access file 3/15/2002
37.85.416 STATISTICAL SAMPLING AUDITS access file 6/30/2000
Subchapter 5
Provider Sanctions
37.85.501 GROUNDS FOR SANCTIONING access file 4/9/2004
37.85.502 SANCTIONS access file 4/9/2004
Rules 37.85.503 and 37.85.504 reserved
37.85.505 FACTORS GOVERNING IMPOSITION OF SANCTION access file 11/16/1984
37.85.506 SCOPE OF SANCTION access file 11/28/1987
37.85.507 NOTICE OF SANCTION access file 6/13/1980
Rules 37.85.508 through 37.85.510 reserved
37.85.511 PROVIDER EDUCATION access file 6/13/1980
37.85.512 NOTICE OF ADVERSE ACTION access file 12/23/2011
37.85.513 SUSPENSION OR WITHHOLDING OF PAYMENTS access file 12/23/2011
Subchapter 6
reserved
Subchapter 7
reserved
Subchapter 8
reserved
Subchapter 9
Physician-Administered Drugs
Rules 37.85.901 and 37.85.902 reserved
37.85.903 PHYSICIAN-ADMINISTERED DRUGS, DEFINITIONS access file 12/25/2008
Rule 37.85.904 reserved
37.85.905 PHYSICIAN-ADMINISTERED DRUGS, BILLING REQUIREMENTS access file 1/1/2013
Subchapter 10
reserved
Subchapter 11
Montana Medicaid Provider Incentive Program for Electronic Healthcare Records
37.85.1101 PURPOSE access file 7/29/2011
37.85.1103 DEFINITIONS access file 7/29/2011
37.85.1105 ELIGIBLE PROVIDER REGISTRATION WITH CENTERS FOR MEDICARE AND MEDICAID (CMS) NATIONAL LEVEL REPOSITORY (NLR) access file 7/29/2011
37.85.1107 ELIGIBLE PROVIDER AND ELIGIBLE HOSPITAL ELIGIBILITY VERIFICATION BY DPHHS access file 7/29/2011
37.85.1109 ELIGIBLE HOSPITAL ELIGIBILITY VERIFICATION BY DPHHS access file 7/29/2011
37.85.1111 REGISTRATION, ATTESTATIONS, AND CERTIFICATION access file 7/29/2011
37.85.1113 REPORTING REQUIREMENTS IN FIRST AND SUBSEQUENT YEARS access file 7/29/2011
37.85.1115 PROOF OF ELECTRONIC HEALTH RECORDS CERTIFICATION access file 7/29/2011
37.85.1117 COMMUNICATION WITH PROVIDERS access file 7/29/2011
37.85.1119 APPLICATION FOR PAYMENTS BY AN ELIGIBLE PROVIDER OR ELIGIBLE HOSPITAL access file 7/29/2011
37.85.1121 ELIGIBLE PROVIDER INCENTIVE PAYMENT SCHEDULE access file 7/29/2011
37.85.1123 ELIGIBLE HOSPITAL INCENTIVE PAYMENT CALCULATION access file 7/29/2011
37.85.1125 DENIALS AND APPEALS access file 7/29/2011
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