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Key Contacts

 

Contact Hours

Hours for Key Contacts are 8 am to 5 pm Monday through Friday (Mountain Time), unless otherwise stated. The telephone numbers designated “In state only” will not work outside Montana.

Addictive and Mental Disorders Division (AMDD) and Adult Mental Health

100 N Park, Suite 300
PO Box 202905
Helena MT 59620-2905
(406) 444-3964 Phone
(406) 444-4435 Fax

For additional contact information for AMDD, please see http://dphhs.mt.gov/amdd/AMDDContact.aspx.

Administrative Reviews and Fair Hearings

To request an administrative review, address or direct the request to the division that issued the contested determination, and deliver or mail to: Administrative Review
DPHHS
2401 Colonial, Third Floor
PO Box 202953
Helena, MT 59620

To request a fair hearing, deliver or mail the request to the following address. A copy of the hearing request must also be delivered to the division that issued the contested determination.
Office of Fair Hearings
DPHHS
2401 Colonial, Third Floor
PO Box 202953
Helena, MT 59620-2953

Ambulatory Surgical Center Program

Send written inquiries to:
ASC Program Officer
Hospital and Physician Services Bureau
PO Box 202951
Helena, MT 59620

(406) 444-4540 Phone
(406) 444-1861 Fax

Chemical Dependency

100 North Park Avenue, Suite 300
PO Box 202905
Helena, MT 59620-2905

(406) 444-3964 Phone
(406) 444-4435 Fax

Children’s Mental Health

111 North Sanders, Room 307
PO Box 4210
Helena, MT 59604-4210

(406) 444-4545

Claims

For answers to all claims questions, call Provider Relations at (406) 442-1837 or 1 (800) 624-3958.

Send paper claims to:
Claims Processing Unit
PO Box 8000
Helena, MT 59604

Claims HMK/CHIP Dental and Eyeglass

Send paper claims to the address above. For questions about dental claims, call Provider Relations. For more information, see the HMK website.

Claims HMK/CHIP Medical

For questions about medical claims, contact BCBSMT. For more information, see the HMK website.

Blue Cross and Blue Shield of Montana (BCBSMT)
(800) 447-7828, Extension 8647 In/Out of state
(406) 444-3456 Fax, In/Out of state

Claims Mental Health Services Plan (MHSP)

Send paper claims to the address in Claims above.

For questions about MHSP claims, contact Provider Relations.

CLIA Certification

For questions regarding CLIA certification, contact:
Quality Assurance Division
DPHHS
2401 Colonial Drive
PO Box 202953
Helena, MT 59620-2953

(406) 438-1793 In/Out of state
(406) 444-3456 Fax, In/Out of state

Critical Access Hospitals Program

For questions regarding critical access hospital (CAH) policies:
(406) 444-4540    Phone
(406) 444-1861    Fax

Send written inquiries to:
Critical Access Hospital Program Officer
Health Resources Division
P.O. Box 202951
Helena, MT 59620

Diabetic Education Services

The hospital’s diabetic education protocol must be approved by:
Medicare Part A Program
P.O. Box 5017
Great Falls, MT  59403

Dialysis Services Program

Send written inquiries to:

Dialysis Program Officer
Hospital and Clinic Services Bureau
DPHHS
P.O. Box 202951
Helena, MT 59620-2801

(406) 444-4540 Phone
(406) 444-1861 Fax

EDI Support Unit

For questions regarding electronic claims submissions:

EDI Support Unit
P.O. Box 4936
Helena, MT 59604

(800) 987-6719 In/Out of state
(406) 442-1837 Helena
(406) 442-4402 Fax

Electronic Funds Transfer/ Electronic Remittance Advices

Providers who need to enroll in electronic funds transfer (EFT) and sign up for electronic remittance advices (ERAs) should contact Provider Relations. Direct deposit is another term for EFT. Completed documentation should be mailed or faxed to:

Provider Relations
P.O. Box 4936
Helena, MT 59604
(406) 442-4402 Fax

FQHC Program

(406) 444-4540 Phone
(406) 444-1861 Fax

FQHC Program
Hospital and Physician Services Bureau
DPHHS
P.O. Box 202951
Helena, MT 59620-2951

Health Improvement Program

For questions regarding the Health Improvement Program (HIP):
Health Improvement Program
Member Health Management Bureau
DPHHS
P.O. Box 202951
Helena, MT 59620.2951

(406) 444-4455 Phone
(406) 444-1861 Fax

Health Insurance Premium Payment (HIPP) Coverage

To apply for this program, contact:
(800) 694-3084 In state
(406) 444-9440 Helena/Out of state

For a HIPP referral, contact your local Office of Public Assistance. Send written inquiries to:
Health Insurance Payment Program
P.O. Box 202953
Helena, MT 59620-2953

Healthy Montana Kids (HMK)

P.O. Box 202951
Helena, MT 59620.2951

(877) 543-7669 (Toll-free, follow menu)
(855) 258-3489 (Toll-free, direct)
(877) 418-4533 (Fax, toll-free)
(406) 444-4533 (Fax, Helena)

Hospital Program

(406) 444-7018    Phone
(406) 444-4441    Fax Send written inquiries to: Hospital Program Officer
Health Resources Division
DPHHS
P.O. Box 202951
Helena, MT  59620-2951

Indian Health Service Program

Send written inquiries to:
IHS Program Officer
Hospital and Physician Services Bureau
PO Box 202951
Helena, MT 59620

(406) 444-4540 Phone
(406) 444-1861 Fax

 

Lab and Imaging

For claims for multiple x-rays of same type on the same day, send to this address. See also Public Health Lab below.

Lab and Imaging
Health Resources Division
DPHHS
PO Box 202951
Helena, MT 59620-2951

Medicaid Help Line

Members who have Medicaid questions may call the Help Line, 1 (800) 362-8312.

Member Eligibility

There are several methods for verifying member eligibility.

Provider Relations
1 (800) 624-3958 or (406) 442-1837
8 am to 5 pm
Monday – Friday
Amount of last payment to provider; claim and enrollment status; member eligibility; prior authorization status; service limits
Have pen and paper in hand when you call; have NPI and member ID available when you call.

FaxBack
1 (800) 714-0075
Available 24/7
Managed care and other restrictions; member eligibility; third party liability
Before using FaxBack, your fax number must be on file with Provider Relations. Call FaxBack and enter your NPI/API, the member’s ID, and specific dates of service.
When prompted, ask for the audit number or the transaction will not be completed.

Integrated Voice Response (IVR)
1 (800) 714-0060
Amount of last payment to provider; managed care and other restrictions; member eligibility; third party liability
Call IVR and enter your NPI or provider number, a member ID, and specific dates of service. Verify eligibility for up to 5 members in one call. Contact Provider Relations for program benefit limits.

Montana Access to Health Web Portal
mtaccesstohealth.acs-shc.com/
Available 24/7
Claim-based medical history; electronic remittance advices; managed care and service restrictions; member demographics; member eligibility; member status history; payment status; provider enrollment; third party liability

Before accessing the MATH web portal, you must be an enrolled Medicaid provider and complete the web portal registration online or by calling Provider Relations. From the Provider Information website, click on the Log in to Montana Access to Health link. If the member is not currently eligible, any managed care or third party liability information will not be displayed. The user will receive a response with a status of “inactive” reported in the Member Demographic Information.

Offices of Public Assistance
http://www.dphhs.mt.gov/hcsd/OfficeofPublicAssistance.aspx

Mountain-Pacific Quality Health (MPQH)

Mountain-Pacific Quality Health
PO Box 6488
Helena, MT 59604

 

 

 

Nurse First

For questions regarding the Nurse First Advice Line, 1-*800-330-7847, contact:
Nurse First Program
Member Health Management Bureau
DPHHS
PO Box 202951
Helena, MT 59620-2951
(406) 444-4455 Phone
(406) 444-1861 Fax

Passport to Health

Passport providers may report errors, omissions, or discrepancies in enrollee utilization and cost reports to:
Passport to Health Program
Member Health Management Bureau
PO Box 202951
1400 Broadway
Helena, MT 59620-2951
(406) 444-4455 Phone, In/Out of state
(406) 444-1861 Fax

Providers who have Passport questions may call the Provider Help Line, 1 (800) 624-3958, or send written inquiries to the address above: Providers who wish to enroll or have Passport questions may also contact the Passport Provider Lead.
PO Box 254
Helena, MT 59624-0254
(406) 457-9558 In/Out of state
(406) 442-2328 Fax

Point of Sale Help Desk

For assistance with online POS claims adjudication:
Technical POS Help Desk
(800) 365-4944
6 a.m to midnight, Monday–Saturday; 10 a.m. to 9 p.m., Sunday (Eastern Time)

Physicians

1400 Broadway
PO Box 202951
Helena, MT 59620-2951
(406) 444-3995 In/Out of state
(406) 444-1861 Fax

Prescription Drug Program

For program policy questions:
Medicaid Services Bureau
1400 Broadway
PO Box 202951
Helena, MT 59620

(406) 444-4540
(406) 444-1861

Presumptive Eligibility

For information on presumptive eligibility, see http://medicaidprovider.mt.gov/presumptiveeligibility.

For information about training or certification, contact Deb Kiel or Justine Welker.

To verify eligibility, contact:

Deb Kiel:
(406) 655-7683
email DKiel@mt.gov

or

Justine Welker
(406) 883-7848
email: JWelker@mt.gov

Pricing, Data Analysis, and Coding (PDAC)

For coding advice and other information:
1 (877) 735-1326 Toll-free
8:30 am to 4 pm, Monday -- Friday, Central Time

PDAC
PO Box 6757
Fargo, ND 58108-6757

Prior Authorization

Refer to the Prior Authorization Information and your provider type manual.

Provider Enrollment

HMK/CHIP Dental and Eyeglass Provider
To enroll as an HMK/CHIP dental provider, contact Provider Relations at 1(800) 624-3958.

HMK/CHIP Medical Provider
To enroll as an HMK/CHIP medical provider, contact BCBSMT at 1 (800) 447-7828, X 6100.

Provider Relations

Contact Provider Relations for general claims questions, questions about enrollment, eligibility, Passport, Medicaid, MHSP, HMK pharmacy, eyeglass and dental payments and denials:

1 (800) 624-3958 In/Out of state
(406) 442-1837 Helena
(406) 442-4402 Fax

Send written inquiries to:
Provider Relations Unit
PO Box 4936
Helena, MT 59604

Public Health Lab

DPHHS Public Health Lab
1400 Broadway
PO Box 6489
Helena, MT 59620

(800) 821-7284 In state
(406) 444-3444 Helena/Out of state

Rural Health Clinic Program

(406) 444-4540 Phone
(406) 444-1861 Fax

RHC Program
Hospital and Physician Services Bureau
DPHHS
PO Box 202951
Helena, MT 59620-2951

Reporting Medicaid Member Waste, Fraud and/or Abuse

DPHHS, Quality Assurance Division, Program Compliance Bureau
To report member waste, fraud and/or abuse, call the Member Fraud Hotline, 1 (800) 201-6308.

Member fraud can include one or more of the following

  • Submitted a false application for Medicaid
  • Provided false or misleading information about income, assets, family members, or resources
  • Shared a Medicaid card with another individual
  • Sold or bought a Medicaid card
  • Diverted for resale or other reasons prescription drugs, medical supplies, or other benefits
  • Participated in doctor or pharmacy shopping
  • Obtained Medicaid benefits that they were not entitled to through other fraudulent means
  • Paying cash for controlled substances
  • Forged prescriptions

Secretary of State

The Secretary of State’s office publishes the Administrative Rules of Montana (ARM).

Secretary of State
PO Box 202801
Helena, MT 59620-2801
(406) 444-2055
Secretary of State Website

Senior and Long-Term Care

2030 11th Avenue
PO Box 4210
Helena, MT 59604-4210
(406) 444-4077

Surveillance/Utilization Review

Send written requests to:

Fraud and Abuse
Surveillance/Utilization Review
2401 Colonial Drive
PO Box 202953
Helena, MT 59620-2953

Team Care Program

For questions regarding the Team Care Program:

(406) 444-4455 Phone
(406) 444-1861 Fax
Team Care Program Officer
Member Health Management Bureau
DPHHS
PO Box 202951
Helena, MT 59620-2951

Third Party Liability

For questions about private insurance, Medicare, or other third party liability:

(800) 624-3958 In/Out of state
(406) 443-1365 Helena

Send written inquiries to:
Third Party Liability Unit
PO Box 5838
Helena, MT 59604

Transportation

When a trip is canceled or rescheduled, return any travel funds to the address below.

Health Resources Division
DPHHS
PO Box 202951
Helena, MT 59620-2951

Address policy questions to:
Program Officer
Health Resources Division
PO Box 202951
Helena, MT 59620-2951


(406) 444-4189 Phone In/Out of state
(406) 444-1861 Fax

Vaccines for Children

Montana State Immunization Program
(406) 444-5580
http://dphhs.mt.gov/publichealth/Immunization

Vaccines for Children
http://dphhs.mt.gov/publichealth/Immunization/VaccinesforChildren

Key Websites

 

Addictive and Mental Disorders

The Health Resources Division (HRD) administers Medicaid physician, acute and hospital/clinic health care services for low-income and disabled Montanans and oversees the benefits of the Healthy Montana Kids (HMK) plan. HRD provides administration, policy development, and reimbursement for primary and acute portions of the Medicaid program. http://dphhs.mt.gov/hrd

American Academy of Pediatrics

http://www.aap.org/en-us/Pages/Default.aspx

Visit the website for information on health initiatives, immunization schedule (http://www2.aap.org/immunization/), news and features, and professional resources.

American Dental Association

http://www.ada.org/en/

A leading source for oral health-related information for dentists and their patients.

Administrative Rules of Montana (ARM)

Blue Cross and Blue Shield of Montana (BCBSMT)

 

Centers for Disease Control and Prevention (CDC

Tracks and investigates public health trends. http://www.cdc.gov/

Centers for Medicare and Medicaid Services (CMS)

An agency within the U.S. Department of Health and Human Services responsible for administration of several key federal health care programs. http://www.cms.gov/

Crime Victim Compensation

Department of Public Health and Human Service (DPHHS)

http://dphhs.mt.gov/

Key Websites

EDI Solutions is the Conduent HIPAA-compliant clearinghouse. Visit http://www.acs-gcro.com/gcro/ for more information on EDI enrollment, EDI support, FAQs, manuals, provider services, and software.

Health Improvement Program (HIP)

This program is part of Passport to Health for Medicaid or Healthy Montana Kids Plus members. HIP uses nurses and health coaches to help Passport members with serious health problems obtain and coordinate the services they need to maintain or improve their health.
http://dphhs.mt.gov/MontanaHealthcarePrograms/HIP.aspx

Health Resources Division

 

Healthy Montana Kids (HMK)

Information on Healthy Montana Kids. http://dphhs.mt.gov/HMK

List of Excluded Individuals/Entities (LEIE)

 

Managed Care

Passport to Health, Team Care, Nurse First, and Health Improvement Program
http://dphhs.mt.gov/MontanaHealthcarePrograms/Welcome/MedicalPrograms.aspx

Medicaid Mental Health and Mental Health Services Plan

Adult and children mental health services information for Medicaid and MHSP.
http://dphhs.mt.gov/amdd/Mentalhealthservices.aspx

Member Information

 

Montana Access to Health (MATH) Web Portal

A secure website on which providers may view members' medical history, verify member eligibility, submit claims to Medicaid, check the status of a claim, verify the status of a warrant, and download remittance advice reports.
https://mtaccesstohealth.acs-shc.com/

Montana Code Annotated

Montana Healthcare Programs Provider Information

Providers can find fee schedules, manuals and manual replacement pages, and provider notices on their provider type pages. Individual pages contain forms, contacts, websites, newsletters, training information, and more.  http://medicaidprovider.mt.gov/

Mountain-Pacific Quality Health

National Correct Coding Initiative

National Plan and Provider Enumeration System (NPPES)

The Administrative Simplification provisions of the Health Insurance Portability and Accountability Act of 1996 (HIPAA) mandated the adoption of standard unique identifiers for health care providers and health plans. The purpose of these provisions is to improve the efficiency and effectiveness of the electronic transmission of health information. The Centers for Medicare and Medicaid Services (CMS) has developed the National Plan and Provider Enumeration System (NPPES) to assign these unique identifiers. https://nppes.cms.hhs.gov/NPPES/

Noridian

Medicare Part B Carrier. https://www.noridianmedicare.com/

Nurse First

The Nurse First Advice Line is a toll-free and confidential nurse triage line staffed by licensed-registered nurses and is available 24/7/365.  Telephone (800) 330-7847
http://dphhs.mt.gov/MontanaHealthcarePrograms/NurseFirst.aspx

Parents Let's Unite for Kids (PLUK)

 

Passport to Health

Passport to Health is the primary care case management (PCCM) program for Montana Medicaid and Healthy Montana Kids (HMK) Plus members. The Passport to Health programs; Health Improvement Program, Team Care and Nurse Advice Line encourage and support Medicaid and HMK Plus members and providers to establish a strong doctor/patient relationship and ensure the appropriate use of Medicaid and HMK Plus service.
http://dphhs.mt.gov/MontanaHealthcarePrograms/Passport.aspx

Presumptive Eligibility

Presumptive Eligibility is available to hospitals and their affiliated facilities that participate with Medicaid in Montana. Personnel from these facilities must be trained and certified to make Presumptive Eligibility determinations for short-term, temporary coverage for qualified coverage groups.
https://medicaidprovider.mt.gov/presumptiveeligibility

Secretary of State

System for Award Management (SAM)

Disbarred entities and entities suspended, proposed for disbarment, excluded, or disqualified under the non-procurement common rule, or otherwise declared ineligible from receiving federal contracts, certain subcontracts, and certain federal assistance and benefits. https://www.sam.gov/portal/public/SAM/

Team Care

Team Care is a Montana Medicaid and Healthy Montana Kids Plus (HMK Plus) program for people who need help using their Medicaid and HMK Plus benefits the right way. People in the Team Care program can be sure to get good healthcare because each person has a team to help manage his/her healthcare.
http://dphhs.mt.gov/MontanaHealthcarePrograms/TeamCare.aspx