Provider Connection

Radiology Revisited

As more clients utilize outside contracted services for the interpretation of their films, the billing of those services is sometimes confusing and results in denials. MSF will accept the following:

  • If both the technical and the professional services were provided in your clinic by providers who are under the clinic’s tax ID, bill the global service and enter the service provider in Box 31.
  • If you are billing only the professional component and the provider is not under the clinic’s tax ID, you may enter “Locum Tenens” in Box 31.
  • If you are billing global and the technical component was provided in your clinic but the professional component was provided by a contracted provider not under the clinic’s tax ID, you can:
    • Bill the technical component separately with the clinic name in Box 31, and
    •  Bill the professional portion separately with “Locum Tenens” in Box 31, or
    •  Bill global; the provider in Box 31 must sign off on reading provider’s report as the dictating physician will not match information in Box 31.

Make sure you submit documentation to support the services billed. If you are not sending an actual radiology report, the documentation in the notes must clearly identify the codes billed and the results. Be sure to get pre-authorization prior to providing services, if applicable. If you have further questions, please contact a member of the MSF Medical Team.

Re-evaluation or Reconsideration Requests

If you are requesting a re-evaluation or reconsideration of a denied or partially denied bill, please send a copy of the Explanation of Review (EOR) with the needed documentation or information to:

Montana State Fund

P.O. Box 4759

Helena, MT 59604-4759

If you are sending in a corrected billing (i.e., corrected code, corrected information in Boxes 31-33, # units, etc.), please write “Corrected Claim” on the billing form, attach a copy of the EOR and mail to the above address. If you are unsure of what is needed, contact CorVel or a member of the medical team.

Pre-authorization

If you don’t know whether a service is related to a workers’ compensation injury, be sure to contact the claim examiner to request pre-authorization prior to providing the service. Physical and occupational therapy (as well as other therapies or services) must be prescribed by the treating physician. The authorization should include the length of time and therapy duration, and must be signed by both the claim examiner and the provider. Pre-authorization does not guarantee payment if services are not related to the injury of record. See the DLI website for additional information regarding pre-authorization.

NPI/Taxonomy Requirements

Remember to enter the applicable National Provider (NPI) Identification Taxonomy numbers on the UB04 and CMS 1500 forms when billing MSF for services. If not present, the bill will be denied. See the Winter 2010 Provider Bulletin for instructions.

Implant Invoices for Outpatient or ASC Facility Services

Invoices for implants are only required if you are requesting additional payment and the implant meets the outlier threshold set by Department of Labor and Industry (DLI):

Inpatient Services $10,000 in cost.
Outpatient/ ASC $500INcost.

Note: Cost includes freight and handling and is added after the cost plus 15 percent calculation.

Chargemaster inventory control sheets and purchase orders are not considered invoices. The actual invoice(s) supporting the actual item(s) implanted must be submitted. See the DLI website (http://erd.dli.mt.gov) for more information regarding implants.

Payment Status

Please allow 30 days before calling for a payment status of a bill or reconsideration request. Most bills are processed within 30 days or returned to the provider with a form indicating needed information.

Psychiatric Coding 101

The following codes are for “Psychiatric Diagnostic or Evaluative Interview Procedures” and do not require time documentation:

90801 – Psychiatric diagnostic interview examination

90802 – Interactive psychiatric diagnostic interview examination using play equipment, physical devices, language interpreter, or other mechanisms of communication.

Codes 90804 – 90809 are used for “Psychiatric Therapeutic Procedures” and do require time documented in the note to substantiate the level billed. These codes are used for individual psychotherapy, INSIGHT ORIENTED BEHAVIOR MODIFYING AND /OR SUPPORTIVE IN AN OFlCE OR outpatient facility with the following face-to-face time allocated to each:

90804-20 – 30 minutes

90805 – with medical evaluation and management services.

90806-45 -50 minutes

90807 – with medical evaluation and management services.

90808-75 -80 minutes

90809 – with medical evaluation and management services.

Codes 90810 – 90815 are used for Interactive Psychotherapy services and also require time documented in the note to support the level billed. These services include individual psychotherapy, interactive, using play equipment, physical devices, language interpreter, or other mechanisms OF NON-VERBAL COMMUNICATION IN AN OFlCE OR OUTPATIENT FACILITY WITH the following time allocated to each:

90810 – 20-30 minutes.

90811 – with medical evaluation and management services.

90812 – 45-50 minutes.

90813 – with medical evaluation and management services.

90814 – 75-80 minutes.

90815 – with medical evaluation and management services.

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)