Gentle Reminders to Get Your Bills Paid on Time — THE FIRST TIME!!!
- Ensure all documentation is attached. Including:
- X-ray reports
- Anesthesia flow sheet(s)
- Physical therapy flow sheet (s)
- Complete treatment notes for all disciplines
- Physical therapy notes must include part(s) of body treated and
- Time documented in the note for codes where time is an element, e.g., MTOO1 and some of the physical medicine codes.
- Correct, full 12-digit claim number. Note: Some IE’s may have more than one claim so contact the Claim Examiner if unsure of correct claim number.
- If supplies are provided, they must be documented in the note. An invoice may be requested. Educational Pamphlets, OTC medications, vitamins and supplements are not reimbursable. For items costing more than $200.00, prior authorization is required from the claim examiner assigned to the IE. Reference ARM 24.29.1522 for the complete rule for reimbursing medical equipment or supplies dispensed through a medical provider office.
- When billing an E/M visit, ensure the documentation supports the level billed and is related to the injury of record. Reference CPT guidelines for the requirements.
1. Requests for re-evaluation of a denied bill or line item may be faxed to 406-444-5963, or mailed to:
Montana State Fund
PO Box 4759
Helena, MT 59601-4759
You must attach a copy of the EOR and the supporting information necessary to request reconsideration for payment.
Note: Do not send the billing form unless you are sending a corrected billing (i.e., Box 31, 32 or 33 corrections; # units; changed code(s); etc.), and clearly mark the bill “Corrected Claim” or “Corrected Billing.”
If a denial is due to no authorization, please contact the Claim Examiner assigned to the injured employee for authorization.
DLI Website Information
http://erd.dli.mt.gov — You will find both the Facility Fee Schedule and the Non-Facility Fee Schedule on this website as well as the Administrative Rules of Montana (ARM) and the instruction set to the Non-Facility Fee Schedule. This site also contains the historical fee schedule information.
For questions regarding these fee schedules call 406-444-6530 and they will direct your call to a DLI representative.