Provider Connection

Changes on the Horizon for Medical Bill Processing and Payment

iStock_3174859StethescopeFor the past several years, Montana State Fund (MSF) has contracted with CorVel Corporation to review medical bills for payment on our behalf. State law requires MSF to periodically go through a competitive bid process for these types of services. MSF completed the process in May of this year and the new contract has been awarded to ACS.

Although ACS is also handling the state’s Medicaid bill processing, there are significant differences between that work and their work for MSF – including, a completely different staff to handle the MSF bills.

ACS will begin processing MSF’s medical bills based on the WC Administrative Rules, the DLI fee schedules and MSF business rules effective January 1, 2011. There are no changes to those as a result of our moving from CorVel to ACS.

We are working with both CorVel and ACS to facilitate a smooth transition to minimize the impact for providers with this change.

To assure a smooth transition from CorVel to ACS, we will stop sending new bills to CorVel effective December 12. CorVel will process anything provided to MSF prior to that date, as well as re-evaluations, refunds and underpayments, through the end of the year. Payments to providers will continue from CorVel into the new year, but for bills from December 12 and prior.

To clear the transactions between CorVel and MSF, bills that arrive after December 12 will be held for ACS processing. MSF will not be able to make payments on those bills until January, and those payments will come through ACS.

We will pay all the bills appropriate for payment, at the appropriate levels, but December payments for bills that arrive at MSF after December 12, will take longer than usual. Our goal is to minimize the delay, but we cannot eliminate it. Denials of bills, not appropriate for payment will see the same delay.

Bills that arrive at MSF on December 13 or later, will see a delay in approval, payment or denial until January as a result of this transition. We expect to be caught up and back to normal processing times by the end of January.

Transition:
For questions regarding the transition contact Bridget McGregor at 406-495-5277.

For bill or payment questions through 12/30/11 please contact CorVel at 1-866-868-3828 or 406-442-6977, or a member of the Medical Team at 406-495-5011. Please remember, CorVel will not have any information regarding bills or reconsideration requests that arrive at MSF after December 12.

For bill status questions for bills that arrive at MSF after December 12, and for all transactions after January 1, 2012 contact ACS at 1-877-591-8028 or a member of the Medical Team at 406-495-5011.

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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)