Provider Connection

Express Scripts Physician Outreach Program – Morphine Equivalent Dose (MED)

OpiodsMSF has been working with Express Scripts, our pharmacy benefit manager, to establish a proactive, aggressive approach to reduce the potential for opioid misuse or abuse by injured workers.  Morphine Equivalent Dose (MED) is the calculation used to determine a narcotic medication’s morphine-like potency in conjunction with its dosage.  Determining a narcotic’s MED is an essential safety factor as one study has shown patients receiving a MED of 100mg or more per day have a 9-fold increase in risk of overdose.

Express Scripts will be calculating the MED levels for the individual prescription and the cumulative levels of narcotics prescribed for an injured worker.  Prescriptions exceeding a threshold MED limit will be flagged for review by our claims examiners and medical staff for prior authorization.  Express Scripts will also be sending letters to prescribers for injured workers who are exceeding 120 MED or more per day.

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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)