Provider Connection

Non-Facility Fee Schedule

 Legislative Update

On December 4, 2009, the Department of Labor & Industry (DLI) held a public hearing in Helena to consider amending Administrative Rules of Montana (ARM) 24.29.1533 and 24.29.1538. The proposed rule changes included:

1) 24.29.1533 (1)(a) the HCPCS codes, including CPT codes, which are incorporated by reference. Unless a special code or description is otherwise provided by rule, pursuant to 39-71-704, MCA, the edition of the CPT publication in effect at the time the medical service is furnished must be used to determine the proper procedure code and discussed in greater detail in (3);

2) 24.29.1533 (1)(b) the RVU given in the 2009  edition of the RBRVS which is incorporated by reference, unless a relative value is otherwise  specified in these rules. Unless a special code or description is otherwise provided by rule, pursuantto 39-71-704, MCA, the edition of the RBRVS in effect at the time the medical service is furnished must be used to determine the proper procedure code. For example, the 2010 version of the RBRVS applies to services provided from January 1, 2010 through December 31, 2010.

3) 24.29.1538 Conversion Factors for Services Provided on or after January 1, 2008 –Methodology: (2) proposed to add the following language for the conversion factor related to services other than anesthesia: If the department determines that a conversion factor does not need to change from theprevious year due to its analysis of the average in

(5), the most current factor listed below applies.

  • No change to the conversion fartor for
    services other than anesthesia.

4) 24.29.1538 (3) proposed to add the following language for the conversion factor related to anesthesia services: If the department determines  that a conversion factor does not need to change from the previous year due to its analysis of the average in (5), the most current factor listed below applies.

  • Changes the current conversion factor for anesthesia services to $60.97.

In a nutshell, DLI is proposing the Current Procedural Terminology (CPT) code and Resource-Based Relative Value Scale (RBRVS) in effect at the date of the service be used
for purposes of calculating the fee schedule. Please keep in mind there are Montana Only codes and values for some services.

There is no proposed change in the Standard Conversion Factor ($65.28) for 2010. The Anesthesia Conversion Factor has been adjusted to $60.97.

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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
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)