Provider Bulletin

Mid Level Provider Information

Mid Level Providers May Assume The Treating Physician Role:

Section 39-71-116 (41) “Treating physician” means the person who, subject to the requirements of 39-71-1101, is primarily responsible for delivery and coordination of the worker’s medical services for the treatment of a worker’s compensable injury or occupational disease and is:
     (a) a physician licensed by the state of Montana under Title 37, chapter 3, and has admitting privileges to practice in one or more hospitals, if any, in the area where the physician is located;
(b) a chiropractor licensed by the state of Montana under Title 37, chapter 12;
(c) a physician assistant licensed by the state of Montana under Title 37, chapter 20, if there is not a treating physician, as provided for in subsection (41)(a), in the area where the physician assistant is located;
(d) an osteopath licensed by the state of Montana under Title 37, chapter 3;
(e) a dentist licensed by the state of Montana under Title 37, chapter 4;
(f) for a claimant residing out of state or upon approval of the insurer, a treating physician defined in subsections (41)(a) through (41)(e) who is licensed or certified in another state; or
(g) an advanced practice registered nurse licensed by the state of Montana under Title 37, chapter 8.

FURTHER:

A mid-level provider can also determine MMI and render an impairment rating:

39-71-711. Impairment evaluation — ratings. (1) An impairment rating:
     (a) is a purely medical determination and must be determined by an impairment evaluator after a claimant has reached maximum healing;
(b) must be based on the sixth edition of the American medical association Guides to the Evaluation of Permanent Impairment;
(c) must be expressed as a percentage of the whole person; and
(d) must be established by objective medical findings and may not be based exclusively on complaints of pain.
(2) A claimant or insurer, or both, may obtain an impairment rating from an evaluator if the injury falls within the scope of the evaluator’s practice and if the evaluator is one of the following:
(a) a physician or an osteopath licensed under Title 37, chapter 3, with admitting privileges to practice in one or more hospitals, if any, in the area where the physician or osteopath is located;
(b) a chiropractor licensed under Title 37, chapter 12;
(c) a physician assistant licensed under Title 37, chapter 20, if there is not a physician as provided for in subsection (2)(a) in the area where the physician assistant is located;
(d) a dentist licensed under Title 37, chapter 4;
(e) an advanced practice registered nurse licensed under Title 37, chapter 8; or
(f) for a claimant residing out of state or upon approval of the insurer, an evaluator referred to in subsections (2)(a) through (2)(e) who is licensed or certified in another state.

Bill Status – 1-877-591-8028

Main Phone Number 406-495-5000 or 800-332-6102

Main Fax  406-495-5020

Medical Team – 406-495-5011

Submit your Claims and/or Correspondence To
Montana State Fund
PO Box 4759
Helena, MT  59604

ACS (Bill Status)
Phone  888-208-2116
Email  MSFBillReviewInquiries@Conduent.com

For questions regarding
: Information in this bulletin, call 800-332-6102 and ask for a member of the Medical Team. Advanced Nurse Review, Kym Vonada at 406-495-5389.


Medical Team

Michele Fairclough
Medical Team Leader
406-495-5362

Heather O’Hara
Nurse Manager
406-495-5458

Justin Kennedy
Medical Management Specialist
406-495-5417

Shannon Hadley
Provider Relations Specialist
406-495-5245

Kym Vonada
Medical Auditor
406-495-5389

Annalyn Stewart
Medical Payment Auditor
406-495-5367

Susan Bomar
Medical Payment Auditor
406-495-5271

Cindy Gallus
Medical Customer Service Liaison
406-495-5189

Sherri Sprenger
Medical Customer Service Liaison
406-495-5420

Shannon Mergenthaler
Medical Customer Service Liaison
406-495-5185

Maggie Pentecost
Medical Customer Service Liaison
406-495-5322

Jamie Statton
Medical Customer Service Liaison
406-495-5386

Website Information

Montana State Fund montanastatefund.com

Department of LaborDepartment of Labor and Industry (DLI) website.
The website includes the Facility and Non-Facility Fee Schedule information as well as the Administrative Rules of Montana (ARM) and the instruction set for the Non-Facility Fee Schedule. Historical fee schedule information can also be found on this website.

If you have questions regarding the fee schedules call 406-444-6530 and someone will direct you to a DLI representative. For NPI information click here National Plan and Provider Enumeration System (NPPES)