Provider Connection

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.

Refund Requests.

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

Re-evaluation Requests.

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.

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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)