Provider Connection

Montana Facility Fee Schedule

Steadily Onward and Upward

Phew! We have finally made it through the launch of the new Montana Facility Fee Schedule (MFFS). The transition has been a little “bumpy” at times, but we are getting “the hang of it!” There has been a significant learning curve as everyone adjusts to the new methodology as adopted bythe Department of Labor & Industry (DLI). Montana State Fund (MSF) Medical Team employees attended training sessions that DLI recently offered. MSF also brought in an expert for some additional training in May. We continue to solicit feedback from DLI as issues arise and encourage you to contact them if you still have questions. You may also access their website at http://erd.dli.mt.gov/wcstudyproject/mffsoverview.asp.

Some “Facility” Housekeeping

When submitting implant invoices that reach the outlier threshold, please DO NOT use a highlighter to identify those items used. Bills cannot be scanned in color and highlighting only blacks out the information. Please circle or check the items used for the procedure. Implant thresholds are $10,000.00 in cost for inpatient hospital and $500.00 in cost for outpatient hospital and ambulatory surgical centers. Reference (ARM) 24.29.1432 (11(e)) and (12(f)) for more information.

Why do we need documentation?

Documentation is an important piece of an injured employee’s (IE’s) treatment: it tells us what treatment is being provided, what additional treatment is planned or needed, what the IE’s improvement  status is and how they are responding to the treatment plan. In general, office notes need to be submitted with every bill and should contain those elements, along with any recommendations and/or referrals for other therapies that may help return the IE to health and the workplace. Of note, treatment should be related to the injury of record in order to be considered for payment. If an IE is seeking treatment for conditions not related to the injury, they should make a separate appointment to have those issues addressed or you may receive a denial for your bill. For more information, reference ARM 24.29.1513.

Note: For facility billing, documentation is not usually required for inpatient hospital or ASC unless submitting implant invoices. Exceptions include new claims and outpatient services for ER, laboratory, radiology, physical therapy and critical access facilities. If inpatient or ASC bills are submitted for new claims without records we cannot process until the records are received. This documentation is often the first available to review for compensability.

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)