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BEFORE THE OFFICE OF FAIR HEARINGS MONTANA DEPARTMENT OF PUBLIC HEALTH AND HUMAN SERVICES In the Mat

BEFORE THE OFFICE OF FAIR HEARINGS MONTANA DEPARTMENT OF PUBLIC HEALTH AND HUMAN SERVICES In the Mat 2025

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The document is a Fair Hearing Decision from the Montana Department of Public Health and Human Services regarding Pharmacies, Inc., which contested an alleged overpayment of Medicaid funds totaling $9,854.10. The Department initially claimed an overpayment of $39,062.82 based on a retroactive audit but reduced this amount after Pharmacies, Inc. provided additional documentation. The core issue revolved around the adequacy of the documentation submitted by Pharmacies, Inc., which included accounting screen prints and electronic data versus the Department's requirement for original paper remittance advice or specific electronic formats. Ultimately, the Hearing Officer ruled in favor of Pharmacies, Inc., reversing the Department's determination of overpayment.

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What does Montana Medicaid cover for adults?

The MT Medicaid program includes comprehensive benefits like doctor and hospital visits, family planning, emergency services, mental health, prescription drugs, rehabilitation, transportation to medical appointments, dental, and vision. Some MT Medicaid members will be responsible for copayments for certain services.

What is the help line for Medicaid in Montana?

Need help finding your local Office of Public Assistance, Enrolled Medicaid Provider, or Passport Provider? Call Montana Healthcare Programs, Member Help Line 1-800-362-8312, M-F, 8am-5pm, for assistance.

What is the Montana help line?

Visit Montana 211 or dial 2-1-1 for resources in your area. Montana 2-1-1 helps connect Montanans with resources and assistance from state and local health and human service programs.

What assistance can I get with Medicaid?

Mandatory benefits include services including inpatient and outpatient hospital services, physician services, laboratory and x-ray services, and home health services, among others. Optional benefits include services including prescription drugs, case management, physical therapy, and occupational therapy.

What are the income limits for Medicaid in Montana?

Approximate Monthly Income to Qualify for Montana Medicaid, 2024 Family SizeAdults 19-64Pregnant Women 1 $1,669 $1,970 2 $2,265 $2,674 3 $2,862 $3,378 4 $3,458 $4,0822 more rows