Provider Connection
What Else is Changing? Keep Track Here.
NPI numbers, new forms and address changes
NPI Numbers
Effective May 23, 2007, all healthcare providers were required by the Department of Health and Human Services to apply for a National Provider Identifier number as a standard identifier. MSF requires the use of the NPI number in addition to the Federal Identification Number on billing forms. To submit your NPI number to us, please contact:
Montana State Fund
P.O. Box 4759
Helena, MT 59604
Fax: 406-444-6445
New CMS 1500 and UB04 Billing Forms.
The new CMS 1500 and UB04 forms are now available through CMS (Centers for Medicare and Medicaid) and your form supplier. The updated forms were approved by the National Uniform Claim Committee to accommodate the use of the NPI and to increase the number of lines that could be billed per form. See the CMS website for further information regarding instructions for the forms.
House Bill 738 – New Fee Schedule Rules.
House Bill 738 will change the way fee schedules are set for non-hospital medical service providers. HB 738 calls for using the top five disability insurers in Montana who utilize the Resource Based Relative Value Scale to determine fees. For more information regarding HB 738, go to the Department of Labor and Industry website at http://dli.mt.gov and click “Public Hearings on Proposed Amendments.” MSF is currently working with CorVel on these proposed changes, which will be ready for implementation on the proposed effective dateof January 1, 2008.
New Address for CorVel Corporation. CorVel Corporation has outgrown their previous location and has moved closer to MSF. Their new address is:
CorVel Corporation
121 North Last Chance Gulch
Suite C
Helena, MT 59601
Phone: 406-442-6977, 1-866-868-3828
Fax: 406-442-6975
Filling Out a CMS 1500 Form. Please be sure all of the following information is submitted:
| Box 1A | Insured’s ID number will be the full 12-digit claim number. |
| Box 2 | Injured employee’s name. |
| Box 3 | Injured employee’s sex and date of birth. |
| Box 5 | Injured employee’s address. |
| Box 10 | “Is patient’s condition related to…” |
| Box 11 | OPTIONAL – 12-digit claim number could again be entered here. |
| Box 12 | The patient (injured employee) or authorized representative must sign/date the form unless there is a signature on file, then “signature on file” is sufficient. |
| Box 21 | Diagnosis – Note: for Vocational Rehabilitation, this box is optional; enter 959.9 for vocational rehabilitation bills. |
| Box 24A | Date(s) of service. |
| Box 24B | OPTIONAL – place of service. |
| Box 24D | Procedures, services or supplies – CPT, HCPCS or contracted codes must be entered here. |
| Box 24E | OPTIONAL – Diagnosis code or number from Box 21. |
| Box 24F | Service charge/fee for each line item/code. |
| Box 24G | Days or units – enter the number of units for each line item/code. |
| Box 24J | NPI (new CMS 1500 form) Physician National Provider Identifier. Providers will need to use this number beginning May 2007. |
| Box 25 | Federal Tax ID number – enter the tax ID or SS # of the billing entity. |
| Box 26 | OPTIONAL – Patient’s (injured employee’s) account number. |
| Box 28 | Total charges. |
| Box 31 | Signature of physician or supplier including degrees or credentials; signature of person providing the service and the date signed. Locum tenens should be entered here if providing the service. |
| Box 32 | Name and address of facility where services were rendered. |
| Box 33 | Billing provider information (official name under Federal Tax ID), address, zip code and phone number –this may be the same as Box 31. |
To substantiate the charges being billed, please attach all documentation, reports and invoices pertinent to the services. If a flow sheet is referenced, please be sure to include it with the bill and other supporting documentation. Supplies must also be documented in the note(s).
To request a re-evaluation of a denial or partial denial, please use the following steps:
- Clearly mark the UB92, CMS-1500 or billing form with “Request for Re-evaluation of Denial.”
- Attach the CorVel Explanation of Review (EOR).
- Attach additional supporting documentation.
- Submit all documentation to:
Montana State Fund5 South Last Chance Gulch
P.O. Box 4759
Helena, MT 59604-4759
FAX 406-444-5963 - MSF will send these documents to CorVel for processing.
