Provider Connection

Coding Updates

medical-coding-and-billing-300x300MT001
This code is Montana specific and should be used for the following services:

    • face to face conferences with payer representative(s) to update the status of a patient upon request of the payer;
    •  a report associated with non-physician conferences required by the payer; or
    • completion of a job description or job analysis requested by the payer.
    • Written questions that require a written response from the provider, excluding the Medical Status Form.

Time must be documented in the submitted record, report or job analysis. The current RVU for MT001 is .54 per 15 minute unit.

99080 is not an appropriate code for reimbursement of the above services.

MT003
When requesting reimbursement for implants, MT003 is required to indicate that an outlier is being requested. The manufacturer’s invoice is required along with the operative report. Please do not whiteout the manufacturer information as it cannot be validated as a manufacturer’s invoice and is sometimes needed when verifying certain items in the operative record.

99211/INR’s
If an injured worker is being seen for a scheduled routine INR and no other services, 99211 would not be a payable service. If the nurse is providing other services not related to the INR but is related to the injury documentation must support the service.   Routine blood pressure checks and vital signs are not considered a separate service.

Bilateral Procedure Calculation Change
Calculation for bilateral procedures has changed slightly with the new rule that became effective July 1, 2014. Providers are instructed to bill all bilateral procedures with modifier 50 (see the Montana Professional Fee Schedule Instruction Set, page 6) on the Department of Labor & Industry website at http://mtwcfeeschedule.ingenix.com/documentations/ProfessionalFeeScheduleInstructionSet2014.pdf.

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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)