Provider Manuals

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AMERICAN INDIAN 638 CLINICS

NEW - Manual Issued December 1, 2009

• Manual Chapter 39 – Title Page

• Table of Contents

• Section 39.0 Overview

• Section 39.1 Covered Services

• Section 39.2 Recipient Requirements

• Section 39.3 Provider Requirements

• Section 39.4 Reimbursement

• Appendix A

DENTAL 

ADA  LICENSE AGREEMENT FOR USE OF CDT CODES 

The dental procedure codes, nomenclatures, and descriptors included in these documents have been obtained or appears verbatim from the Current Dental Terminology (CDT) – 2009/2010.  CDT (including procedures codes, definitions (descriptors) and other data) is copyrighted by the American Dental Association. ©2008 American Dental Association.  All rights reserved.  Applicable FARS/DFAES apply.

Note: The fee schedules for the EPSDT Dental, EDSPW and Adult Denture Programs have been updated for dates of service on or after November 1, 2006. To access the current schedules, click on the link entitled “Fee Schedules”. The revised schedules may be printed for your convenience. The fee schedules located in the Appendix section of the online Dental Service Manual are not current. These schedules will be revised at a later date.

• Dental Program Claims Filing, Chapter 7(E) - Issue Date May, 1, 2003

• Dental Services Policy Manual, Chapter 16 - Issue Date May 1, 2003

MENTAL HEALTH REHABILITATION

UPDATE Revisions as of 08/01/09

• Manual Chapter 31 – Title Page

• Section – Table of Contents

• Section 31.0 – Overview

• Section 31.1 – Services

• Section 31.2 – Service Access/Authorization

• Section 31.3 – Provider Certification and Recertification

• Section 31.4 – Program Operations

• Section 31.5 – Staffing and Training

• Section 31.6 – Record Keeping

• Section 31.7 – Program Monitoring

• Section 31.8 – Administrative Sanctions

• Section 31.9 – Financial Reimbursement

• Section 31.10 – Acronyms/Definitions

• Appendix A - Hardware and IT Requirements

• Appendix B - Letter of Attestation

• Appendix C - DHH Research Policy

• Appendix D - Service Log

• Appendix E - Message to EPSDT Eligibles and Parents

MULTI-SYSTEMIC THERAPY

NEW - Manual Issued December 1, 2009

• Manual Chapter 42 – Title Page

• Table of Contents

• Section 42.0 Overview

• Section 42.1 Covered Services

• Section 42.2 Medical Necessity

• Section 42.3 Provider Requirements

• Section 42.4 Program Operations

• Section 42.5 Staffing and Training

• Section 42.6 Record Keeping

• Section 42.7 Claims Related Information

• Section 42.8 Program Monitoring

• Section 42.9 Administrative Sanctions

• Section 42.10 Acronyms/ Definitions/ Terms

• Appendix A - Service Log

• Appendix B - DHH Research Policy

PERSONAL CARE SERVICES

NEW - Revised Manual Issued November 1, 2009

• Manual Chapter 30 – Title Page

• Section – Table of Contents

• Section 30.1 – LT-PCS Overview

• Section 30.2 – LT-PCS Covered Services

• Section 30.3 – LT-PCS Recipient Criteria

• Section 30.4 – LT-PCS Recipient Rights and Responsibilities

• Section 30.5 – LT-PCS Service Authorization Process

• Section 30.6 – LT-PCS Provider Requirements

• Section 30.7 – LT-PCS Service Delivery

• Section 30.8 – LT-PCS Record Keeping

• Section 30.9 – LT-PCS Quality Assurance

• Section 30.10 – LT-PCS Incidents, Accidents and Complaints

• Section 30.11 – LT-PCS Reimbursement

• Section 30.12 – LT-PCS Fraud and Abuse

• Appendix A – LT-PCS Correspondence

• Appendix B – LT-PCS Agreement to Provide Services

• Appendix C – LT-PCS Plan of Care

• Appendix D – LT-PCS Service Log

• Appendix E – Billing Information

• Appendix F – LT-PCS Contractor Information

• Appendix G – Acronyms/Definitions

PHARMACY

• Pharmacy Benefits Management Services, Chapter 37 - Updated February 19, 2010

• Appendix A - List of Drugs Payable on Drug File

• Appendix A-1 - New List of FUL and SMAC prices for payable drugs

• Appendix B - List of DESI Drugs by National Drug Code (NDC)

• Appendix C - Medicaid Drug Federal Rebate Participating Pharmaceutical Companies

• Appendix D - Point of Sale User Guide

• Appendix E - List of Medications and Correct Decimal Quantities - Updated November 01, 2008

• Appendix F - RXPA Form - Prescribers use to request drug Prior Authorizations

• Appendix G - Universal Drug Claim Form and Instructions - Updated December 2, 2009

• Appendix H - Form 211 - Drug Adjustment/Void Form and Instructions

• Appendix I - PA01 Form - TPN Prior Authorization Form

• Appendix J - CMS 1500 - To be used in submitting TPN Claims  and CMS 1500 Instructions

• Appendix K - Form 213 - TPN Adjustment/Void Form and Instructions

• Appendix L - Table of Tamper Resistant Prescription Criteria and Examples