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Montana Behavioral Health
Providers • Announcements
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Update to CMBH Manual for 2015
NEW! CMHB (Children's Mental Health Bureau) Manual for 2015 has been posted.
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
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
Important Psychiatric Residential Treatment Facility (PRTF) Reminders
Please click here to read this DPHHS Montana Health Care Programs Notice issued on April 02, 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
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.
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.
Effective 07/01/2011, Targeted Youth Case management services do not require Prior authorization or Unscheduled
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.
Please note: the Adult Request forms have been updated as of September 8, 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.
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.
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:
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!
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.
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.
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:
We apologize for any inconvenience this may cause.
New Online Tool Manages Access to First Health Services Prior Authorization
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
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.
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
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