Provider Connection

NPI Revisited

Provider NPI information is required on the CMS 1500, UB04 and ADA forms. Listed below are instructions for where to provide this data on the billing forms:

CMS 1500

  1. Field 17a: Referring Provider Taxonomy – input ZZ and 10-character taxonomy code without spaces.
  2. Field 17b: Referring Provider NPI # – input 10-character NPI number.
  3. Field 24i: ID Qualifier – ‘Blank’ and Preprinted ‘NPI’ spaces. Blank space should be populated with ZZ for taxonomy code without spaces listed in 24J.
  4. Field 24j: Rendering Provider ID # – If ‘blank’ 24I is populated with ZZ, enter 10–digit taxonomy code without spaces in 24j.
    1. Enter the NPI number in the corresponding space after preprinted ‘NPI’ in 24I.
  5. Field 32a: Service Facility Location NPI # – enter 10-character NPI number.
  6. Field 32b: Service Facility Location Taxonomy – input ZZ and 10-character taxonomy code without spaces.
  7. Field 33a: Billing Provider NPI # – input 10-character NPI number. If not present the bill will be denied for this omission.
  8. Field 33b: Billing Provider Taxonomy – input ZZ and 10-character taxonomy code without spaces.

UB04

  1. Field 56: Billing Provider NPI – input 10-character NPI number. If not present the bill will be denied for this omission.
  2. Field 57: Billing Provider Taxonomy – input ZZ and 10-character taxonomy code without spaces.
  3. Field 76: Attending Provider NPI – input 10-character NPI number.
  4. Field 77: Operating Provider NPI – input 10-character NPI number.
  5. Fields 78/79: Other Providers NPI – input 10-character NPI number.
  6. Field 81: Billing Provider Taxonomy – input B3 and 10-character taxonomy code without spaces. If not present the bill will be denied for this omission.

ADA Dental Claim Form

  1. Field 49: Billing Provider NPI – input 10-character NPI number. If not present the bill will be denied for this omission.
  2. Field 54: Treating Dentist NPI – input 10-character NPI number.
  3. Field 56A: Treating Provider Specialty Code – input 10-character taxonomy code without spaces.
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)