Montana Department Of Public Health & Human Services Prior Authorization Lookup
- Montana Department Of Public Health & Human Services coverage criteria
- All Montana Department Of Public Health & Human Services policy updates
Latest Montana Department Of Public Health & Human Services prior authorization updates21
- Prior AuthReimbursement/Payment PolicyEff. 2025-10-01HEART Waiver Tenancy Support: Application Fee and Security Deposit AssistanceDefines eligibility, provider and service requirements, prior authorization and reimbursement rules for one-time application fee and security deposit assistance under the Montana HEART Waiver Tenancy Support Service (TSS). Affects Montana Medicaid-enrolled members and enrolled TSS providers who deliver Pre-Tenancy Services.All Montana Department of Public Health & Human Services updates
- Prior AuthClinical/Medical PolicyEff. 2025-01-01HEART Waiver - Tenancy Support Service - Application Fee and Security Deposit AssistancePolicy governing one-time transition and move-in cost assistance (application fees and security deposits) for Montana Medicaid members enrolled in the HEART Waiver Tenancy Support Service (TSS). It specifies eligibility, provider and service requirements, prior authorization, and reimbursement procedures.All Montana Department of Public Health & Human Services updates
- Prior AuthAdministrative/Operational PolicyEff. 2023-01-01Montana Medicaid State Plan Amendment: Remove ENA prior authorization & make IOP permanentRemoves prior authorization for EPSDT Extraordinary Needs Aides (ENA) and adds Intensive Outpatient (IOP) mental health services as a permanent Medicaid benefit effective Jan 1, 2023; applies to Montana Medicaid administration, providers, and beneficiaries.All Montana Department of Public Health & Human Services updates
- Prior AuthClinical/Medical PolicyEff. 2022-10-01Acute Inpatient Hospital ServicesDefines coverage, medical necessity, provider and service requirements, and utilization management for acute inpatient psychiatric hospital services for Montana Medicaid members, including prior authorization rules for out-of-state placements.All Montana Department of Public Health & Human Services updates
- Prior AuthAdministrative/Operational PolicyEff. 2022-10-01Requesting Prior Authorization - Non-Acute ServicesGoverns how providers request prior authorization for non-acute behavioral health and developmental disability services under Montana Medicaid and which portal and timelines apply. Affects providers submitting prior authorization requests for non-acute services.All Montana Department of Public Health & Human Services updates
- Prior AuthAdministrative/Operational PolicyEff. 2021-04-08BSW 728 Services: Residential HabilitationDefines eligibility, service components, provider requirements, limitations, prior authorization, and retainer day rules for Residential Habilitation services under Montana's Big Sky Waiver for assisted living, specialized assisted living, group homes, adult and youth foster care.All Montana Department of Public Health & Human Services updates
- Prior AuthAdministrative/Operational PolicyEff. 2021-02-09BSW 718 Services: Non-Medical TransportationGoverns non-medical transportation services available to Montana Big Sky Waiver members to access services, activities, and resources in their service plans; outlines eligibility, provider requirements, limits, and prior authorization rules.All Montana Department of Public Health & Human Services updates
- Prior AuthClinical/Medical PolicyEff. 2021-02-03BSW 737 Services: Vehicle ModificationsPolicy governing coverage, requirements, and limitations for vehicle modifications to enable Montana Big Sky Waiver members' independence, including bidding and prior authorization rules for providers and members.All Montana Department of Public Health & Human Services updates
- Prior AuthAdministrative/Operational PolicyEff. 2020-07-01Prior AuthorizationThis policy defines prior authorization types and requirements for Home and Community Based Services (HCBS) under the Severe and Disabling Mental Illness (SDMI) waiver and describes which services require prior authorization and by whom.All Montana Department of Public Health & Human Services updates
- Prior AuthReimbursement/Payment PolicyEff. 2020-07-01ReimbursementGoverns reimbursement rules, billing, prior authorization, and payment requirements for the Montana SDMI Home and Community-Based Services (HCBS) waiver; affects providers, contracted case management teams, and Medicaid members participating in the SDMI HCBS waiver.All Montana Department of Public Health & Human Services updates
- Prior AuthClinical/Medical PolicyEff. 2020-03-01Disaster & Emergency Telehealth and Related Benefit FlexibilitiesDefines temporary Montana Medicaid flexibilities to permit and reimburse telemedicine/telehealth (including telephone and messaging), suspend or extend prior authorizations, adjust prescription day supplies and refills, and add limited waiver supplies during the COVID-19 state of emergency. Affects Montana Medicaid members, providers, and waiver programs during the declared emergency.All Montana Department of Public Health & Human Services updates
- Prior AuthClinical/Medical PolicyEff. 2014-07-01Outpatient Drugs, Fraud, Waste, and Abuse — Coverage CriteriaRequirements and controls for outpatient prescription drugs for Montana Medicaid, Healthy Montana Kids, and Mental Health Services Plan members, including fraud/abuse definitions, refill limits, prior authorization triggers, and opioid prescribing limits.All Montana Department of Public Health & Human Services updates
- Prior AuthAdministrative/Operational PolicyEff. 2000-07-01Home Health visits — eligible services, limitations, and exclusionsDefines where Home Health services may be provided, the composition of Home Health visits, annual visit limits, authorization periods, and prior authorization requirements for Montana Medicaid beneficiaries.All Montana Department of Public Health & Human Services updates
- Prior AuthClinical/Medical PolicyBig Sky Waiver Specialized Medical Equipment and Supplies (Service Limitations)Defines coverage, prior authorization, provider and equipment requirements, allowable and excluded specialized medical equipment and supplies under the Big Sky Waiver program and rules Case Managers must follow when requesting payment or authorization.All Montana Department of Public Health & Human Services updates
- Prior AuthAdministrative/Operational PolicyBig Sky Waiver policy manual revisions and constituent meeting outcomesSummarizes the October 29, 2020 constituent meeting about proposed changes to the Big Sky Waiver policy manual, covering eligibility, slot categories, and prior authorization topics; affects DPHHS waiver staff, providers, and stakeholders involved in Big Sky Waiver implementation.All Montana Department of Public Health & Human Services updates
- Prior AuthClinical/Medical PolicyHome Health Aide ServicesDefines eligibility, duties, supervision, service limits, and prior authorization requirements for Home Health Aide services provided to Montana Medicaid members under the Home Health Policy 506.All Montana Department of Public Health & Human Services updates
- Prior AuthClinical/Medical PolicyHome Health Policy 710 — Services to Children (PDN interaction)Defines Montana Medicaid coverage rules for home health services provided to children (under 21), requires consideration of private duty nursing (PDN) first, documents when Home Health may be used if PDN is unavailable, prior authorization requirements for PDN, and non-reimbursement for oversight/case management.All Montana Department of Public Health & Human Services updates
- Prior AuthReimbursement/Payment PolicyMontana Medicaid Transportation (FAQ)This FAQ explains Montana Medicaid transportation services (personal, specialized non-emergency, commercial, ambulance), prior authorization requirements, billing and reimbursement processes, and contact resources for members and providers.All Montana Department of Public Health & Human Services updates
- Prior AuthClinical/Medical PolicyOutpatient Drug Coverage, Formulary, Prior Authorization, and Dispensing LimitsRules governing Medicaid reimbursement, formulary, prior authorization, dispensing limits, rebate obligations, and development of the preferred drug list for outpatient drugs under Montana Medicaid; applies to providers, pharmacies, manufacturers, and the Medicaid Drug Formulary Committee.All Montana Department of Public Health & Human Services updates
- Prior AuthAdministrative/Operational PolicyPrior Authorization Process: Initial and Extended Prior AuthorizationsGoverns prior authorization requirements and procedures for initial and extended Home Health services for Montana Medicaid; applies to Home Health Agencies (HHAs) and the Department's Utilization Review Contractor.All Montana Department of Public Health & Human Services updates
- Prior AuthClinical/Medical PolicyProposed Changes to Autism State Plan: ABA Services Coverage CriteriaProposed changes to Montana's Autism State Plan governing Medicaid-covered ABA services for members up to age 21, expanding eligible diagnoses, modifying prior authorization and service unit rules, and changing caregiver presence and assessment requirements.All Montana Department of Public Health & Human Services updates
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Tool Description
Search Montana Department Of Public Health & Human Servicesprior authorization policies by drug name, procedure, or policy title. Results include any policy that mentions prior authorization requirements (drug coverage criteria, imaging guidelines, site-of-service rules) not just documents titled “prior authorization.” Every result links to a full policy page with clinical criteria, covered billing codes, documentation requirements, and effective dates.
Filter by payer, specialty, policy type, or effective year; or search directly for a drug (“Wegovy,” “Ozempic”), a procedure (“MRI,” “knee arthroplasty”), or a policy number.
Coverage spans 110+ payers. Jump straight to the busiest prior-auth publishers: UnitedHealthcare, Cigna, Aetna, Anthem, and Centene. You can also browse the full policy updates feed.
Pair a prior-auth search with the billing code lookup to confirm the CPT or J-code on the claim, the payer lookup for plan footprint, and payer profiles for contacts and coverage context.
FAQ
Type a drug name (“Wegovy,” “Ozempic”), a procedure (“MRI,” “knee”), or a policy title into the search bar. Filter results by payer, specialty, policy type, or effective year. Open any result for the full policy page with clinical criteria, covered billing codes, documentation requirements, and effective dates.
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