Provider Connection
Reconsideration/Re-Evaluation Results
August 23, 2012
When requesting a re-evaluation or reconsideration of denied payment you must submit the following documentation in the order listed:
- A copy of the EOR,
- Corrected CMS 1500 or UB04 (if applicable) and write “Corrected Claim” on billing form), and
- Additional documentation or information (if applicable)
Submit to Montana State Fund at the address listed in the contact information in this Bulletin.
