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Utilization and Treatment Guidelines

nurseLegislative Updates

Utilization and Treatment Guidelines

The Montana Department of Labor & Industry (DLI) held a hearing June 6, 2011, to adopt the Utilization & Treatment Guidelines (Montana Utilization and Treatment Guideline, 1st Edition, 2011) and medical services rules. U&T Guidelines were passed as part of House Bill 738 in the 2007 legislative session and the draft form may be found at

The U&T Guidelines will take effect July 1, 2011, and will change the way treatment is provided within workers’ compensation. Some of the highlights are:

  • The Montana U&T Guidelines are based on Colorado’s U&T Guidelines and the Official Disability Guidelines of the American College of Occupational and Environmental Medicine (ACOEM).
  • Prior authorization process changes based on U&T Guidelines. Prior authorization will only be required when:
    • The treatment(s) or procedure(s) is not specifically addressed or recommended by the U&T Guidelines for a body part that is covered by a guideline,
    • After maximum medical improvement, or
    • Beyond the duration and frequency limits set out in the guidelines.
  • A medical advisor will be employed by DLI to:
    • Monitor new procedures and technologies.
    • Consult with health care providers with relevant experience and education.
    • Provide an annual review of the evidence-based Utilization and Treatment Guidelines.
    • Review requests for any treatment(s) or procedure(s) that is not specifically addressed or recommended by the U&T Guidelines, when those requests have been initially denied.
  • There are two types of medical services within the U&T Guidelines: primary and secondary.
    • Per MCA 39-71-116 – primary medical services means treatment prescribed by a treating physician, for conditions resulting from the injury, necessary to achieving medical stability.
    • Per MCA 39-71-116 – secondary medical services are those medical services or appliances that are considered not medically necessary for medical stability.
  • The U&T Guidelines will include nine chapters:
    • Low Back Pain
    • Lower Extremity
    • Shoulder Injury
    • Upper Extremity
    • Chronic Region Pain Syndrome
    • Cervical Spine Injury
    • Chronic Pain Disorder
    • Traumatic Brain Injury
    • Eye Injury

Please see the DLI website for complete information regarding the U&T Guidelines at

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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)