How Do I Submit a Claim to Medicaid

Claim Instructions

Note: The most efficient way for claims to be submitted is electronically.
Claims submitted electronically are processed an average of 14 days faster than paper claims.
Paper claims submitted via mail are processed an average 12 days faster than paper claims submitted via fax.

There are two ways to submit claims to the Montana Healthcare Programs: Electronic and paper.  Electronic claims are processed much faster.  The information below is intended to support claim submission in both formats. The information is divided in two sections. The first section contains documents supporting electronic claim submissions. The second section contains documents supporting paper claim submissions.

Electronic Billing Instructions

See Electronic Submission Setup below to begin the process.

For information about HIPAA 5010,visit the HIPAA5010 page on this website

Please continue to check the Announcements for updates.

Whether you submit one claim a month or hundreds, any provider can benefit from switching from paper to electronic billing. Whether by using the free WINASAP 5010 software or by using a clearinghouse to submit claims, electronic billing is faster, more accurate, and more secure.

You need a personal computer with Windows 98 and above to submit electronically via WINASAP 5010.

See Electronic Submission Setup below to begin the process.

For information about HIPAA 5010,visit the HIPAA5010 page on this website

To bill claims electronically using the WINASAP software, a provider must enroll with EDI Solutions and download the WINASAP software from the EDI website.

WINASAP 5010 Software Download
WINASAP 5010 is a Windows-based electronic claims entry application for Montana Medicaid. If you have questions regarding WINASAP 5010, contact the EDI Support Unit at 1.800.987.6719.

WINASAP 5010 User Guide

Follow the steps below to submit your Medicaid claims electronically.

STEP 1

Download the electronic billing enrollment forms and instructions below. Complete and submit the forms to the address/fax number listed on the enrollment form.

Clearinghouses or Billing Agents

EDI Submitter Enrollment Packet for X12N Transaction
All forms must be completed. To print individual sections, access the links below.

• EDI Provider Enrollment Form Instructions

• EDI Submitter Enrollment Form

• EDI Trading Partner Agreement

• 835 Request Form

• Electronic Billing Agreement (EBA)

Individual Providers

EDI Submitter Enrollment Packet for X12N Transaction
Providers may omit pages 1 and 6 of the EDI Provider Enrollment Form. To print individual sections, access the links below.

• EDI Provider Enrollment Form Instructions

• EDI Provider Enrollment Form

• 835 Request Form

• EDI Trading Partner Agreement

• Electronic Billing Agreement (EBA)

For multiple providers to appear on your drop-down list in the Montana Access to Health web portal, your NPI/API and submitter/trading partner number must be linked. To do so, complete and submit the form below.

• Montana Access to Health Web Portal Link Request

STEP 2

Click WINASAP 5010 to download the WINASAP 5010 software directly to your computer.

• You must have completed the enrollment packet and received your welcome letter before using the software.

• Although the WINASAP software shows the default user as ADMIN this is not the same as Running as Administrator which you must do in order to not lose data. Refer to the manual for assistance.

• Providers previously registered on the MATH web portal who have a Trading Partner ID and now want to bill electronically must call Provider Relations to ensure they have access.

• Basic computer and keyboarding skills are necessary to use this software.

• Technical support is limited for this free software.

STEP 3

For assistance using WINASAP, please download the PDF version of the Montana Users Guide.

Please read the Montana Users Guide prior to calling Provider Relations with questions.

• Although the WINASAP software shows the default user as ADMIN this is not the same as Running as Administrator which you must do in order to not lose data.

• The Montana Users Guide contains important information required for billing. Answers to most questions can be found by referencing the Users Guide, including those regarding hardware requirements.

• Technical support is limited for this free software.

Instructions for Uploading Claims With 3rd Party Billing Software

The electronic claim files must be X12 (HIPAA) compliant. You cannot upload a file larger than 100MB (megabytes) in size.

If they are not, or you are having trouble uploading the files, please contact your billing software provider to ensure the X12 files have been enabled. Provider Relations is unable to service or assist with these programs.

Providers must enroll with EDI in order to bill through MATH. See the Electronic Submissions Setup section for instructions.

To upload an X12 compliant file to the web portal for Claims Submission please follow these steps:

1. Log in to the MATH website with your user id and password
   
2. Choose your organization and submit
   
3. Choose upload files.
   
4. Choose your submitter id from the drop down menu. Enter the path of the file or click 'Browse' to select a file.
   
   
5. Click upload
   
   
6. You should receive an error message immediately if there is something wrong with the data submitted. In the example below, the provider/biller should correct the following error according to the message and continue. Other wise, you will will receive a message indicating successful submission.  In that case, go to step 7.
   The following file upload was not successful:
   

In the example above, the provider/biller should correct the following errors:.

• "The file you attempted to upload contains a Submitter ID 7779999 that does not match the Submitter ID 7109434 you selected from the list. Your file has not been uploaded."
• After the error is corrected, upload the file again.

7.  The image below is the message you will receive if your upload is successful.

Montana Medicaid reimburses only for drugs that are manufactured by companies that have a signed rebate agreement with CMS. An updated list of these manufacturers has been posted on the provider type pages under Other Resources/Rebateable Manufacturers.

To determine if a manufacturer has signed a rebate agreement, check the first five digits of the National Drug Code (NDC) against the list. If there is no match, the drug is not reimbursable.

The list will be updated quarterly, so check regularly to assure coverage.

In addition, the valid NDC must be recorded on the claim (no spaces, no punctuation) as an 11-digit series of numbers. Claims will be denied for drugs billed without a valid 11-digit NDC. Providers also must be careful when entering the NDC quantity (the administered amount). A list of the most commonly used NDCs is available for providers.

Paper Claims Instructions

Note: Claims submitted on paper via mail or fax generally take longer to process.

Montana Medicaid reimburses only for drugs that are manufactured by companies that have a signed rebate agreement with CMS. An updated list of these manufacturers has been posted on the provider type pages under Other Resources/Rebateable Manufacturers.

To determine if a manufacturer has signed a rebate agreement, check the first five digits of the National Drug Code (NDC) against the list. If there is no match, the drug is not reimbursable.

The list will be updated quarterly, so check regularly to assure coverage.

In addition, the valid NDC must be recorded on the claim (no spaces, no punctuation) as an 11-digit series of numbers. Claims will be denied for drugs billed without a valid 11-digit NDC. Providers also must be careful when entering the NDC quantity (the administered amount). A list of the most commonly used NDCs is available for providers.

How Do I Submit a Claim to Medicaid

Source: https://medicaidprovider.mt.gov/claims

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