Provider Connection

Treatment Guidelines

Avoid Payment Problems for Injections
The Guidelines have very specific requirements for documenting the results of injections.  It is a common scenario to see no documentation of the injection result, until the patient tries to retrospectively recall their post-injection response weeks or months later.  However due to the unreliable nature of those retrospective reports the Guidelines consider it “obligatory” that a detailed concurrent log be kept.  The Guidelines require hourly recordings in many circumstances.  An “Injection Log” is downloadable from MSF’s website. (www.montanastatefund.com – I am a Medical Provider – Provider Resources – Injection Log).

This Injection Log is not perfect for all circumstances, but it will satisfy the documentation requirements for recording the results of injections and therefore avoid problems with your payments for that injection or approval for future injections.

For more details directly from the Guidelines you can go to the downloadable pdf version on pages:
Cervical Spine Chapter pages 17 – 20 and 29 – 35 and
Low Back Pain Chapter pages 14-17 and 27 – 32.


Avoid Approval/Payment Problems for Medial Branch Rhizotomies
The Guidelines require diagnostic medial branch blocks and a certain degree of improvement for a patient to qualify for the rhizotomy procedure.  Because of the reported high incidence of false positives with a single block, a second comparative or control block with a different duration anesthetic or placebo is required by the Guidelines.  The Guidelines require that both blocks be documented with an Injection Log.

To avoid approval and payment problems, follow the Guidelines for diagnostic injections and medial branch blocks with a comparative/control block.  The Guidelines do not accept intra-articular facet injections as predictive of response to medial branch rhizotomy.  Therefore they are not used to determine eligibility for rhizotomy.   Details are available from the Guidelines, again from the pdf downloadable version:

Cervical Spine Chapter pages 17 – 20 and 29 – 35 and
Low Back Pain Chapter pages 14-17 and 27 – 32.


Acetaminophen Prescription Products Limited to 325 mg Per Dosage Unit
Acetaminophen, a commonly used drug, is widely and effectively used in both prescription and over-the-counter (OTC) products to reduce pain and fever.  Over the past few years healthcare professionals have been reminded by the FDA to advise patients not to exceed the acetaminophen maximum total daily dose (4 grams/day), and not to drink alcohol while taking acetaminophen-containing medications.   As of 1/1/2014, in an effort to reduce the risk of acetaminophen related liver injury, the FDA has instituted a 325 mg per dosage unit limit on all acetaminophen products.  This means prescriptions with more than this limit cannot be filled through our pharmacy benefit manager, Express Scripts.

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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)