Provider Connection

Passage of House Bill 334

As a result of HB 334, insurers are able to approve the medical provider chosen by the injured employee or designate an appropriate treating physician for injuries and occupational diseases occurring after July 1, 2011. In part because of this change in the law, effective July 8 MSF will end its relationship with Montana Health Systems, a contracted managed care organization used to assist us with managing claims. Claims actively enrolled in the MCO will continue care with their MCO-designated treating physician and will receive additional payment based on fee schedule changes delineated below.

A brief synopsis of HB 334 as it pertains to payment of medical bills:

  • Closure of medical benefits 60 months from the date of injury or date of diagnosis of occupational disease on or after July 1, 2011.
  • Choice of physician – an injured employee can choose a treating physician (subject to approval by the insurer or the designation of another provider). The treating physician will:
    • Coordinate the medical care.
    • Provide timely determination such as MMI, return to work, restrictions, etc.
    • Provide or arrange for treatment within the Utilization and Treatment Guidelines.
    • Conduct or arrange for timely impairment ratings.
    • Receive 110 percent of the fee schedule amount if designated by the insurer as the treating physician (other providers will receive 90 percent to 100 percent of fee schedule depending upon role).
  • Medical Fee Schedules – Beginning July 1, 2011, the DLI rates and relative value units as of December 31, 2010, are to be used until June 30, 2013. Fee schedule reimbursement will vary based on provider status:
– Treating physician (as designated by the insurer) 110% of fee scheduled amount
– Initial/emergency health care provider 100% of fee scheduled amount
– Other providers referred by the treating physician 90% of fee scheduled amount
  • A universal workers’ compensation Medical Status Form will be created by DLI and completion will be required by the treating physician after every visit.
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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)