Provider Connection

U & T Guidelines: Physical Therapy – When the Threshold is Not Enough

Brandy_Rehab2The Montana Utilization and Treatment Guidelines (adopted effective 7/1/11, ARM 24.29.1591 – 24.29.1599) by the Montana Department of Labor and Industry established guidelines for providing treatment for primary and secondary medical services based on the injured part of body including chronic regional pain syndrome and chronic pain disorder. All health care providers must use these guidelines when treating an injured worker.

When physical therapy services are needed beyond the duration and frequency limits set out in the Guidelines, providers must obtain prior authorization pursuant to MCA 39-71-704 and in accordance with ARM 24.29.1593. For MSF injured workers, a provider may request additional treatment by completing and submitting the Therapy Precert Request form for approval. Information must include the proposed treatment plan, measurable functional goals and any work recommendations. This form may be downloaded at montanastatefund.com. Click on the I am a Medical Provider tab, then click Provider Resources, scroll down and you will find the Therapy Precert Request form.

After completing the form, please Fax to 1-800-495-5020. The claims examiner assigned to the injured worker will approve or disapprove the request and fax the determination back to the provider.

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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)