Provider Connection

UB04 Documentation Requirements

Expedite payment with the right paperwork

There seems to be some confusion about what documentation needs to be sent when billing for hospital services. Submission of the following items will help expedite payment.

  • UB04
  • Itemization
  • Therapy service documentation (i.e. PT/OT/RT)
  • Radiology reports*
  • Laboratory reports
  • Physician orders
  • Medication administration records, including IV
  • Anesthesia record including flow sheet
  • Pre and Post operative records
  • Implant listing

*Providers may only bill for radiology services that are provided directly. Global services cannot be billed when a provider completes the technical component and contracts for external radiological services to read the radiographs. The provider listed in Box 31 of the CMS 1500 form must be the provider performing the service.

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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

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

Justin Kennedy
Nurse Manager

Shannon Hadley
Provider Relations Specialist

Kym Vonada
Medical Auditor

Annalyn Stewart
Medical Payment Auditor

Sheryl Semans
Pharmacy Liaison

Susan Bomar
Medical Payment Auditor

Cindy Gallus
Medical Customer Service Liaison

Sherri Sprenger
Medical Customer Service Liaison

Shannon Mergenthaler
Medical Customer Service Liaison

Maggie Pentecost
Medical Customer Service Liaison

Jamie Statton
Medical Customer Service Liaison

Website Information

Montana State Fund

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)