Rules
AHS Health Care Administrative Rules. This link will take you to The Agency of Human Services Health Care Administrative Rules (HCAR) page to view the regulations adopted by the Agency of Human Services that govern the administration of Vermont Medicaid.
The Agency of Human Services is undertaking a comprehensive revision of Medicaid rules across the Agency of Human Services and its Departments. The Medicaid Covered Services Rules above will be amended and adopted under the title of Health Care Administrative Rules (HCAR). This is a multi-year process, and during this transition phase, some Medicaid rules will remain in the Medicaid Covered Services Rules (7100 - 7700), while other rules will be adopted in the new HCAR collection of Medicaid rules.
Manuals
Detailed Summary of Updates. This is a companion document to the New Consolidated Provider Manual, detailing all changes on and after 10-1-2012.
340B Medicaid Carve In Manual. Program and Enrollment Guidelines for the 340B Medicaid carve in.
Applied Behavior Analysis Supplement. Provider manual with requirements and guidance for service delivery.
For Agency of Human Services Rules visit https://humanservices.vermont.gov/rules-policies.
Children’s Integrated Services Manual. PES Guidance Manual: CIS Bundled Claims for Non-Medicaid Populations & Zero-pay Encounter Claims
CMS-1500 and UB-04 Billing Guide. Provider guidance for paper claim billing instructions and field locators for CMS-1500 and UB-04 claims
Dental Supplement. Provider Manual with billing instructions related to dental claims.
For Agency of Human Services Rules visit https://humanservices.vermont.gov/rules-policies.
Dental Supplement Summary of Changes. Summary of changes to the Dental Supplement Manual
Durable Medical Equipment Supplement. Provider Manual with billing instructions related to DME supplies.
For Agency of Human Services Rules visit https://humanservices.vermont.gov/rules-policies.
Eating Disorder Treatment Services Supplement. Provider Manual for admitting facilities when Vermont Medicaid primary members are receiving Eating Disorder Treatment services.
For Agency of Human Services Rules visit https://humanservices.vermont.gov/rules-policies.
Electronic Visit Verification Guide. A guide for interacting with Sandata for Electronic Visit Verification (EVV). Refer to this document for frequently asked questions and resources.
Enrollment and Billing Guide for High-Technology Nursing Providers. Enrollment and Billing Guide related to High-Technology Nursing Providers.
Federally Qualified Health Centers and Rural Health Clinics. Provider Manual with billing instructions for FQHC and RHC providers.
For Agency of Human Services Rules visit https://humanservices.vermont.gov/rules-policies.
Fee Schedules. Fee Schedule of CPT/HCPCS Codes.
General Billing and Forms Manual. Provider Manual with billing instructions for all providers.
For Agency of Human Services Rules visit https://humanservices.vermont.gov/rules-policies.
General Provider Manual. Provider Manual with billing instructions for all providers.
For Agency of Human Services Rules visit https://humanservices.vermont.gov/rules-policies.
High-Technology Nursing Program Manual. Provider Manual related to the High-Technology Nursing Program.
For Agency of Human Services Rules visit https://humanservices.vermont.gov/rules-policies.
Home Health Agency, Assistive Community Care and Enhanced Residential Care. Provider Manual with billing instructions for HHA, ACC and ERC providers.
For Agency of Human Services Rules visit https://humanservices.vermont.gov/rules-policies.
Mental Health Services Supplement. Provider manual with requirements and guidance for service delivery.
Non-Emergency Medical Transportation Manual. Provider Manual with billing instructions related to NEMT.
For Agency of Human Services Rules visit https://humanservices.vermont.gov/rules-policies.
Pharmacy Provider Manual. Provider Manual with billing instructions related to pharmacy claims.
For Agency of Human Services Rules visit https://humanservices.vermont.gov/rules-policies.
Physical Therapy, Occupational Therapy and Speech Language Therapy. Provider Manual with billing instructions for PT, OT and ST providers.
Primary Care Provider Manual. Provider Manual with billing instructions for Primary Care Providers.
For Agency of Human Services Rules visit https://humanservices.vermont.gov/rules-policies.
Psychotherapy and Other Psychiatric Services Supplement. Provider Manual with billing instructions related to psychotherapy and other psychiatric services.
For Agency of Human Services Rules visit https://humanservices.vermont.gov/rules-policies.
Supervised Billing Manual for Behavioral Health. Provider Manual with billing instructions for Supervised Billing for Behavioral Health Services.
For Agency of Human Services Rules visit https://humanservices.vermont.gov/rules-policies.
Vision Supplement. Provider Manual with billing instructions related to vision claims.
Archived Provider Manual. The Provider Manual has been merged with the following Supplements: UB04, CMS1500 and Prior Authorization on 10-1-2012. The Detailed Summary of Updates has been removed from this document.
Archived Appendix to the Provider Manual. This is a companion document to the Archived Provider Manual, it contains: Addresses & Contact Numbers, Glossary of Terms & Phrases, Abbreviations, Voice Response System (VRS), Sample Remittance Advice, Listing of Forms & Manuals, Insurance Coverage Matrix and the Julian Date Calendar.