Provider Connection

Clean Claim and Corrected Billing

Clean Claim

We continue to receive claims that cannot be processed due to missing or invalid information. The most common errors resulting in denials for clean claim are:

  • Box 10a – Should reflect ‘YES’ if services are related to a work related injury;
  • Box 14 – Incorrect date of injury (or no date of injury listed), please call MSF if you do not have this date. It is also listed on the EOR.
  • Box 24J – Missing rendering provider which typically coincides with the provider name listed in Box 31;
  • Box 32 and/or 32a – If place of service is other than 12 (home), then Box 32 must denote the facility name and physical address where services were provided. Box 32a must include the NPI for this entity;
  • Box 33a – Missing the NPI for the billing provider.

A complete list of required fields by bill type can be found by going to the right hand corner of this publication and clicking More Articles from the Archive. From there click on Provider Bulletin | Winter 2012, then Clean Claim Defined” .


Corrected Billing Submission
When submitting a corrected billing, providers should make sure that the integrity of the original billing is maintained and the billing form clearly reflects that it a corrected billing. Corrected bills must be submitted with a copy of the denial EOR.

Rebilling new bills (or combining bills) with only codes that were denied on other bills will cause delays and errors in processing due to the amount of time it takes to research each code and date of service (DOS). If the submission of a corrected billing is due to the correction of a code, the corrected bill should contain the same codes (even if already paid) from the original bill with the exception of the corrected code. This allows easy comparison of previous processing so the bill can be processed quickly and correctly. If the previous bill is only missing a procedure code, please submit a separate bill with the appropriate documentation for processing. If you have questions regarding how to resubmit a bill, call the Medical Audit Team at the number listed in the Contacts section of this bulletin.

Reconsideration/Re-evaluation Requests – Please submit the following when requesting a reconsideration or submitting a corrected bill:

  • A copy of the EOR
  • Corrected CMS 1500/UB04 (if applicable) and indicate on the bill that it is a “Corrected” bill, and
  • Any additional documentation or information (if applicable).
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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)