Provider Connection

HB119

HB119 was signed by Governor Brian Schweitzer on April 1, 2009. The new law, with a short title of “Revise employment laws, including workers’ compensation,” made several changes that relate to the medical fee schedule:

  • Fee schedule rates are based on standards adopted by the Centers for Medicare & Medicaid Services (CMS) for:
    • CPT (Current Procedural Terminology) Codes
    • HCPCS (Healthcare Common Procedure Coding System ) Codes
    • MS-DRGs (Medicare Severity Diagnosis-Related Groups)
    • APCs (Ambulatory Payment Classification)
    • RCCs (ration of Cost to Charges)
    • CCI Edits (Correct Coding Initiative)
    • RVUs (Relative Value Units) for the most recent RBRVS (Resource-Based Relative Value Scale) in effect on date of service.

Note: The most current editions in effect at the time of the service are used to calculate reimbursement for dates of service on or after April 1, 2009.

  • 30-day rule: When a claim has been accepted and no disputes exist, balances not paid within 30 days accrue interest at a rate of 12% per year or 1% per month or a fraction of a month from the date of receipt of the original billing. The interest requirement also applies to return of overpayments or unpaid amounts after a dispute is resolved. This will apply to claims that have been accepted and bills that are not in dispute (i.e., claims that involve no issue of incorrect codes, lack of treatment notes for services other than inpatient services, unrelated body part, etc.). Reference ARM 24.29.1406.
  • After mediation between an insurer and a provider, unresolved disputes are brought before the Workers’ Compensation Court.
  • For services available in Montana, insurers may pay facilities located outside Montana according to the workers’ compensation fee schedule of the state where the medical service is performed.

Refund requests:  MSF’s Finance Department has recently mailed refund request letters to providers. The original request for refund may be found on the CorVel Explanation of Review (EOR) mailed at the time of bill processing. If the allowed amount on the EOR is in parenthesis this indicates that a refund is due MSF. The letters you may have received are for monies still outstanding. EOR’s were attached to identify the overpayment. If you have received a letter and have a question regarding what is owing, please call a member of the Medical Team to assist you.

Please submit all refunds directly to MSF and attach any supporting documentation to your payment, including a copy of the EOR from CorVel or Montana Health Systems.

Exception: If returning a CorVel check that has not been cashed, the check should be returned to:

CorVel Corporation

121 North Last Chance Gulch

Helena, MT 59601

New Requirements for NCCI Reporting: MSF must submit specific data elements to NCCI to meet insurance reporting requirements. The following data fields mst be provided when billing for medical services on a CMS 1500 or a UB04 form:

CMS 1500

Box # Description
2 Injured employee’s name
3 Injured employee’s date of birth/sex
5 Injured employee’s address
10 Is patient’s condition related to…?
11 Claim number
12 The injured employee’s or authorized representative’s signature, or Signature on File
14 Accident/Injury date
18 Hospitalization dates related to current services
21 ICD-9 diagnosis code(s)
24A Date(s) of service
24B Place of service code
24D CPT, HCPCS or contracted code(s) for procedures, services or supplies
24E ICD-9 code related to code billed per line
24F Service charge/fee billed per line
24G # Days or unit(s) billed per line
24J NPI (National Provider Identifier)
25 Federal Tax ID
28 Total Charges
31 Signature of physician or supplier, including degrees or credentials (Locum tenens if applicable)
32 Name and address of facility where services were rendered (not a P.O. Box)
33 Physician’s or supplier’s billing name, address, zip code and phone number

UB04

Field Locator Description
1 Provider name, address and phone number
3a Patient control number
3b Medical record number
4 Type of bill
5 Federal Tax ID
6 Service dates
8 Injured employee’s name (patient name)
9 Injured employee’s address
10 Injured employee’s date of birth
11 Injured employee’s sex
12 Admission date
13 Admit hour
14 Type of admit
15 Admit source
17 Discharge status
42 Revenue code
43 Revenue code description
44 CPT/HCPCS codes (or contracted codes)
45 Service date
46 Units of service
47 Total charges
56 NPI
58 Insured’s name
60 Claim unique ID number (claim number)
66 ICD-9 code qualifier (version 9)
67 67=1 Principal diagnosis code, 67 (A-H) Other diagnosis codes
69 Admit diagnosis
70a-c Patient reason for visit
74 Principal procedure code
74a-e Other procedure codes and dates (inpatient)
76 Attending provider name and NPI (National Provider Identifier)
77 Operating provider name and NPI
78 Other provider name and NPI
79 Other provider name and NPI
back to Provider Connection

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)