Provider Connection

Gentle Reminders to Get Your Bills Paid on Time — THE FIRST TIME!!!

  1. 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
  1. Time documented in the note for codes where time is an element, e.g., MTOO1 and some of the physical medicine codes.
  2. 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.
  3. 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.
  4.  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.

Re-evaluation Requests:

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 — 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.

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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)