Provider Connection

Designated Treating Provider/Worker Status Form

Report-an-Injury-MasterProviders who have accepted Montana State Fund’s designation of “Treating Physician” (refer to Montana Code Annotated 2011 39-71-1101) must complete a Medical Status Form at each visit with an injured worker. This form may be downloaded from (You will find the form under the Help Me Find section on the right hand corner of the homepage).

Per Montana ARM, the responsibilities of the designated treating provider include:

  • Coordination of all medical care;
  • Providing timely determination of Maximum Medical Improvement (MMI), return to work, work restrictions, job analyses, etc;
  • Providing or arranging for treatmet within the utilization and treatment guidelines;
  • Conducting or arranging for timely impairment ratings;
  • Submission of necessary documentation to include the office notes and Medical Status form after each office visit.

A designated treating provider is paid an additional 10% over fee schedule for the completion of these duties. Please reference the FAQ’s on the Montana State Fund or Department of Labor & Industries websites listed on the Points of Contact section of this newsletter.

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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

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

Justin Kennedy
Nurse Manager

Shannon Hadley
Provider Relations Specialist

Kym Vonada
Medical Auditor

Annalyn Stewart
Medical Payment Auditor

Sheryl Semans
Pharmacy Liaison

Susan Bomar
Medical Payment Auditor

Cindy Gallus
Medical Customer Service Liaison

Sherri Sprenger
Medical Customer Service Liaison

Shannon Mergenthaler
Medical Customer Service Liaison

Maggie Pentecost
Medical Customer Service Liaison

Jamie Statton
Medical Customer Service Liaison

Website Information

Montana State Fund

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)