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Montana Behavioral Health

Providers • Announcements

General Announcements

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Title
Title
What's New - March 28, 2007
What's New - August 10, 2006
What's New - January 17, 2006


Archived Web Announcements

October 2015

Update to CMBH Manual for 2015

NEW! CMHB (Children's Mental Health Bureau) Manual for 2015 has been posted.

October 2013

Changes to Prior Authorization Requirements for Therapeutic Youth Group Homes – Additional Information

Please click here to read this DPHHS Montana Health Care Programs Notice issued on September 27, 2013

September 2013

Important Changes to Contract with Magellan Medicaid Administration (MMA)

Please click here to read this DPHHS Montana Health Care Programs Notice issued on September 24, 2013


Important Changes to Contract with Magellan Medicaid Administration (MMA)

Please click here to read this DPHHS Montana Health Care Programs Notice issued on August 31, 2013

April 2013

Important Psychiatric Residential Treatment Facility (PRTF) Reminders

Please click here to read this DPHHS Montana Health Care Programs Notice issued on April 02, 2013

February 2013

Important Psychiatric Residential Treatment Facility (PRTF) Requirements

Please click here to read this DPHHS Montana Health Care Programs Notice issued on February 19, 2013

October 2012

Updates for Montana Youth Services Providers

  • Revised Children’s Mental Health Bureau’s Provider Manual and Clinical Guidelines for Utilization Management (UR Manual) – effective 10-1-12
  • Revised Appeal & Administrative Review (AR) Process in UR Manual
  • The appeal and administrative review request language in the notification letters and form will be revised to reflect changes in 10-1-12 UR Manual. Until the letters are changed, the timelines in the UR Manual apply.
  • Revised Prior Authorization (PA) and Continued Stay Request (CSR) forms recommend a licensed or in-training mental health professional complete the form. However, this is not a requirement. If the credentials of the person completing the form are not on the form, indicate “Other.”
  • The following revised PA forms require the provider to substantiate the youth’s SED diagnosis and functional impairment.
    • Psychiatric Residential Treatment Facility (PRTF)
    • Partial Hospital (PHP) Program
    • Therapeutic Group Home (TGH)
  • The Permanency Level Therapeutic Foster Care PA form was not changed, however, the provider must substantiate the youth has an SED in the “Reason for Admission” section.
  • The PRTF and PHP PA web-based forms have not been updated. Substantiate the youth’s SED diagnosis and functional impairment in the “Reason for Admission” section.
  • There are additional requirements for the ICPC to place youth in out-of-state PRTF and TGH facilities, see Provider Notice on MTMedicaid.org dated 9-26-12.

August 2011

Effective 08/12/2011, the maximum number of authorized days for Therapeutic Group Home services, procedure code S 5145 will be 120 for both Initial and Continued Stay Reviews.

July 2011

Effective 07/01/2011, Targeted Youth Case management services do not require Prior authorization or Unscheduled Revision reviews.

January 2011

Children’s Mental Health Bureau has effected the following changes in CPT Codes for therapeutic group home, therapeutic family care, and therapeutic foster care:

  • Effective 01/15/2011 Therapeutic group home use procedure code S5145 for prior authorization and continued stay requests.
  • Effective 01/15/2011 Moderate level therapeutic family care to use procedure code H2020 for prior authorization and continued stay requests.
  • Effective 01/15/2011 Moderate level therapeutic foster care use procedure code S5145 and modifier HR for prior authorization and continued stay requests.
  • Effective 01/15/2011 Permanency level therapeutic foster care use procedure code S5145 and modifier HE for prior authorization and continued stay requests.
  • Effective 01/15/2011 Community-based psychiatric rehabilitation and support (CBPRS) services do not require prior authorization when provided on the same day as CSCT, Day Treatment or partial hospital services, if CBPRS is provided before or after program hours. This includes both individual and group CBPRS.

September 2010

Please note: the Adult Request forms have been updated as of September 8, 2010.

July 2010

IMPORTANT CHANGES TO THE MONTANA ONLINE PRIOR AUTHORIZATION SYSTEM!

As of July 31st, the url to access the HCM Web prior authorization system is changing. Please click here to read information that will allow you to work efficiently without interruption to daily procedures for receiving your PA.

May 2010

Changes to CMHB policy

Effective July 1, 2010, a completed Discharge Planning Form (re:Youth/Forms) will be required for all Continued Stay requests for Psychiatric Residential Treatment Facility (PRTF) per State of Montana, DPHHS, CMHB policy.

October 2009

Updates to Manuals

The PRTF Waiver Provider Manual went to the State on 10/01/2009 with updates on the initial prior authorization being moved from 6 to 12 months, as well as continued stays. The program has been amended to include 17 yr olds.

The Adult IOP Manual has been updated to reflect new medical necessity and is now posted on this site.

An OP Manual (which does not exist) is in the works and being reviewed by the State.

The Therapeutic Living Services Provider Manual is still in the works, waiting for the approved ARMs from the Secretary of State.

For your quick reference here is the contact information for the six Regional Care Coordinators (RCC) and their contact information:

Region Name Contact Number
Region Name Contact Number
Region I Stephanie Frame 406-941-0991
Region II Julie Prigmore 406-781-1521
Region III Vonda Nicholson 406-670-1288
Region IV Lowell Luke 406-431-2839
Region V Staci Lindsay 406-370-3175
Adult RCC Gene Durand 406-370-6756

July 2008

FirstHCM now available to TYCM providers

The FirstHCM application is now available for access to all TYCM providers. If you choose to register your facility, you will be able to:

  • Submit authorization requests via the Internet;
  • Look up authorization determinations online;
  • Print or save (to HTML format) copies of determination letters;
  • Eliminate faxing!

Please click the "UAC" link in the upper right corner to register your site!

June 2008

NPI: Full Implementation Effective June 30, 2008

Effective June 30, 2008, only the National Provider Identifier (NPI) or the Atypical Provider Identifier (API) can be used on Montana authorization requests and correspondence submitted to First Health Services. Traditional Provider Medicaid/legacy numbers are no longer valid for use.

December 2007

SED Process for Youth Outpatient Services

New procedure: A letter of Verification of SED will be provided, in conjunction with the letter indicating that OP services are authorized.

August 2007

Fax Outage

Important: Please be advised that First Health Services is performing telephone system maintenance between Friday 08/17 10:30 PM ET thru Monday 08/20 7:00 AM ET. During that time you will be unable to fax to the following HCM number:
800/639.8982
We apologize for any inconvenience this may cause.

June 2007

New Online Tool Manages Access to First Health Services Prior Authorization Requests

First Health Services is launching a new, innovative web-based registration and user management tool that allows providers to control and mange users’ access to FHSC applications on their behalf. The User Administration Console (UAC) is an application that puts the control and maintenance of user access in the hands of the organization.

This change is effective Monday, July 2, 2007. Current users of the FirstHCM web-based prior authorization application will continue to login and use the application as they do today. New users will have to be registered according to procedures described in documentation and tutorials available by clicking here. Our UAC application also provides additional security functionality for providers and users. Please read our Provider UAC letter for more information.

April 2007

NPI Communication No. 1

To comply with the National Provider Identifier (NPI) Final Rule, First Health Services is requiring that all NPI-eligible Medicaid providers furnish their NPI and Taxonomy Code to First Health Services no later than 05/01/2007. This single, unique NPI number is being assigned to all health care providers by the National Plan & Provider Enumeration System (NPPES).

Be advised that the Health Insurance Portability and Accountability Act of 1996 (HIPAA) will require NPI on all electronic claim submissions effective 05/23/2007 and may be required by health plans on paper claims. Providers are responsible for disclosing their NPI to entities that need the NPI for a standard transaction. First Health Services is considered a covered entity and can receive this number.

We are announcing that Health Care Management (HCM) Web providers are now able to report their NPI number via the HCM Web system. Procedures for reporting and updating provider profiles within the First Health online prior authorization system, FirstHCM, are already established. Please review these in the Reporting NPI Information tutorial on this Web site dedicated to the provider community. (Note: secure logon required.)

If the NPI and Taxonomy information is not on file with First Health Services, and if it is the only provider number included on your prior authorization request submitted for approval/review, First Health Services will be unable to cross reference this with the Medicaid number that we have on file. It is essential that if any NPI related information is reported to First Health Services that it be identical to that reported to the State of Montana in order to ensure consistency. Include NPI along with Taxonomy and Zip. Failure to report NPI information accurately as reported to the state may result in delays in processing prior authorization requests.

Please review the tutorial on the First Health Web site as stated above. Medicaid number is still the only required number for processing a request with First Health, but after May 23, our request for services will accept the NPI as it applies to your facility.

Thank you for your promptness and cooperation with this initiative!

First Health Services Corporation

March 2007

New Forms Available

With the release of our Web submission site for prior authorization, the paper forms for submission have been updated to be in synch with the information for a review found on the Web site. Please go to the Provider tab above and select the appropriate forms link needed. You can then download the new updated forms as needed. The information requested on these forms is key to making an informed determination on your patient’s case. The deadline for using the old forms is May 1, 2007. After that time any reviews faxed must be on the newer forms