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 9/9/2023 37.85.105 EFFECTIVE DATES, CONVERSION FACTORS, POLICY ADJUSTERS, AND COST-TO-CHARGE RATIOS OF MONTANA MEDICAID PROVIDER FEE SCHEDULES 3/23/2024 37.85.106 MEDICAID BEHAVIORAL HEALTH TARGETED CASE MANAGEMENT FEE SCHEDULE 9/9/2023 Subchapter 2 Miscellaneous 37.85.201 SELECTION OF PROVIDER 7/1/1999 Rules 37.85.202 and 37.85.203 reserved 37.85.204 MEMBER REQUIREMENTS, COST SHARING 1/18/2020 37.85.205 RECIPIENT RESTRICTION OF ACCESS TO MEDICAL SERVICES REP 7/23/2004 37.85.206 SERVICES PROVIDED 5/7/2016 37.85.207 SERVICES NOT PROVIDED BY THE MEDICAID PROGRAM 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 9/9/2017 Rules 37.85.213 through 37.85.218 reserved 37.85.219 MOBILE IMAGING/PORTABLE X-RAY SUPPLIER 1/1/2017 37.85.220 INDEPENDENT DIAGNOSTIC TESTING FACILITIES 1/1/2013 37.85.221 MEDICAID OVERPAYMENT AUDITOR EVALUATION HEARINGS; RECOVERY AUDIT CONTRACTOR (RAC) PROGRAM 6/23/2018 Subchapter 3 reserved Subchapter 4 Provider Requirements 37.85.401 PROVIDER PARTICIPATION 3/11/1997 37.85.402 PROVIDER ENROLLMENT AND AGREEMENTS 3/11/1997 37.85.403 ICD CLINICAL MODIFICATION (CM) AND PROCEDURAL CODING SYSTEM (PCS) SERVICES 12/25/2014 Rules 37.85.404 and 37.85.405 reserved 37.85.406 BILLING, REIMBURSEMENT, CLAIMS PROCESSING, AND PAYMENT 3/1/2018 37.85.407 THIRD PARTY LIABILITY 5/30/2020 Rules 37.85.408 and 37.85.409 reserved 37.85.410 DETERMINATION OF MEDICAL NECESSITY 3/11/1997 37.85.411 PROVIDER RIGHTS 6/30/2000 37.85.412 INTERPRETATION OF RULES 4/1/2005 37.85.413 LIMITATIONS ON CODING ADVICE 4/1/2005 37.85.414 MAINTENANCE OF RECORDS AND AUDITING 4/1/2005 37.85.415 MEDICAL ASSISTANCE MEDICAID PAYMENT 3/15/2002 37.85.416 STATISTICAL SAMPLING AUDITS 6/30/2000 Subchapter 5 Provider Sanctions 37.85.501 GROUNDS FOR SANCTIONING 4/9/2004 37.85.502 SANCTIONS 4/9/2004 Rules 37.85.503 and 37.85.504 reserved 37.85.505 FACTORS GOVERNING IMPOSITION OF SANCTION 11/16/1984 37.85.506 SCOPE OF SANCTION 11/28/1987 37.85.507 NOTICE OF SANCTION 6/13/1980 Rules 37.85.508 through 37.85.510 reserved 37.85.511 PROVIDER EDUCATION 6/13/1980 37.85.512 NOTICE OF ADVERSE ACTION 12/23/2011 37.85.513 SUSPENSION OR WITHHOLDING OF PAYMENTS 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 12/25/2008 Rule 37.85.904 reserved 37.85.905 PHYSICIAN-ADMINISTERED DRUGS, BILLING REQUIREMENTS 1/1/2013 Subchapter 10 reserved Subchapter 11 Montana Medicaid Provider Incentive Program for Electronic Healthcare Records 37.85.1101 PURPOSE 7/29/2011 37.85.1103 DEFINITIONS 7/29/2011 37.85.1105 ELIGIBLE PROVIDER REGISTRATION WITH CENTERS FOR MEDICARE AND MEDICAID (CMS) NATIONAL LEVEL REPOSITORY (NLR) 7/29/2011 37.85.1107 ELIGIBLE PROVIDER AND ELIGIBLE HOSPITAL ELIGIBILITY VERIFICATION BY DPHHS 7/29/2011 37.85.1109 ELIGIBLE HOSPITAL ELIGIBILITY VERIFICATION BY DPHHS 7/29/2011 37.85.1111 REGISTRATION, ATTESTATIONS, AND CERTIFICATION 7/29/2011 37.85.1113 REPORTING REQUIREMENTS IN FIRST AND SUBSEQUENT YEARS 7/29/2011 37.85.1115 PROOF OF ELECTRONIC HEALTH RECORDS CERTIFICATION 7/29/2011 37.85.1117 COMMUNICATION WITH PROVIDERS 7/29/2011 37.85.1119 APPLICATION FOR PAYMENTS BY AN ELIGIBLE PROVIDER OR ELIGIBLE HOSPITAL 7/29/2011 37.85.1121 ELIGIBLE PROVIDER INCENTIVE PAYMENT SCHEDULE 7/29/2011 37.85.1123 ELIGIBLE HOSPITAL INCENTIVE PAYMENT CALCULATION 7/29/2011 37.85.1125 DENIALS AND APPEALS 7/29/2011