When submitting a corrected bill (CMS 1500 or UB04), please mark the bill “CORRECTED BILL” to indicate that there has been a change to the original billing. Please include a copy of the EOR and any records to support the charges.
If multiple services were billed on a CMS 1500 but not all services were paid, please resubmit the original bill with the additional information or reason that you are requesting reconsideration. Do not bill those lines on a new bill or add them to a new billing. This will maintain the integrity of the original billing and reduce denials for duplicate charges. Submit your request with a copy of the EOR and records or information to support the request.
When submitting additional records, please attach a copy of the bill, the EOR and the request for reconsideration and mail to:
MONTANA STATE FUND
PO BOX 4759
HELENA, MT 59604