Provider Connection

Billing and Coding Clarifications

calculatePaperwork, paperwork – unfortunately it is a necessary evil. To help you complete your documentation correctly from the start, and get you paid in a timely manner, we have outlined a few billing and coding clarifications below.

Implants/MT003

Under the MFFS Montana Administrative Rules (ARM) 24.29.1433(11)(e) and 24.29.1433(12)(f), when additional reimbursement is requested for implants, MT003 must be used.

Cost thresholds are $10,000.00 for inpatient and $500.00 for outpatient hospital or surgery centers. Manufacturer invoices must be submitted as well as the operative record. An implant record and/or itemization provides information that can be very helpful with reconciling the invoice(s) for calculation of reimbursement.

Physical Rehabilitation and Time

The Department of Labor and Industry’s (DLI) adoption of the “Rule of 8’s” made documenting actual time spent on each modality and/or procedures essential in order to correctly calculate the total number of units payable.

8-22 minutes =            1 unit

23-37 minutes =          2 units

38-52 minutes =          3 units

53-67 minutes =          4 units

Please ensure  your documentation clearly indicates actual modalities or therapies performed. If referencing a flow sheet, be sure it is included with the bill and other documentation. For further information please go to the DLI website .

99080/Medical Status Form

Filling out the Medical Status Form is not a billable service. It is to be included in the normal E/M visits. Please see ARM 24.29.1513 for more information.

Morphine Equivalent Dosing Letter – MT001

When billing for a response to the Morphine Equivalent Dosing Letter that is sent out when opioid medications are over 120 MED threshold per day use the Montana only code MT001

Please do not use 99080 or 99199 as these will be denied for incorrect code.

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Bill Status – 1-866-274-7464

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

RMS (Bill Status)
Phone  866-274-7464
Email customer.care@risingms.com

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


Medical Team

Michele Fairclough
Medical Team Leader
406-495-5362

Justin Kennedy
Nurse Manager
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

Sheryl Semans
Pharmacy Liaison
406-495-5010

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)