Pharmacy Benefit Manager
National medical health card aids prescription drug system
As you are aware, on May 3, 2004, MSF implemented a pharmacy benefit manager program (National Medical Health Card) for prescription drug processing and payment.
In response to changes in the drug market and available clinical data, MSF has revised the preferred drug list. Any medication not included on the preferred drug list REQUIRES PRIOR AUTHORIZATION BEFORE -3& WILL ACCEPT liability for payment. The revised preferred drug list may be accessed at www.montanastatefund.com. Click on Providers, and select Pharmacy Benefit Manager FAQs from the column on the left.
Your notification of a request for refund by CorVel/MSF will be an Explanation of Review (EOR). Letters will no longer be generated for that purpose. If you have a question about the refund request, contact CorVel at 866-868-3828 or 406-442-6977. If they are unable to answer your question(s), please contact MSF at 800-332-6102 and ask for a member of the Medical Team.
Please mail refunds to CorVel or MSF:
Montana State Fund
PO Box 4759
Helena, MT 59604
If you request a re-evaluation of a previously denied bill or partially denied bill, please mark the CMS 1500 form with “Request for Re-evaluation” and send it with a copy of the EOR and supporting documentation to MSF. This should eliminate denials for duplicate submissions.
Importance of Claim Number Accuracy.
Please be sure the complete 12-digit claim number is on all correspondence/billing that is sent to MSF. Any documentation received without all 12 digits will be returned to the provider. If you don’t know the claim number, contact the MSF Claims’ Examiner assigned to the case.