Department of Public Health and Human Services

Montana Healthcare Programs Provider Information ยป Passport to Health

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Passport to Health

Passport to Health

What Is Passport?
Useful information for providers on the Passport to Health Program and how to obtain Passport approval. 07.2014

Passport Q&A
Get answers to the most commonly asked Passport questions. 08.2013

Passport Publications

  • Passport to Health 11.2015
    Everything a provider needs to know to become a successful Passport provider.

Provider Notices

Forms

Health Improvement Program Provider Referral Form 09.2015

Providers should fill out this form and fax it to 406.444.1861.

Passport Agreement Amendment to Add Providers 08.2013

Providers should complete this amendment to the Passport provider agreement when adding new providers to a group practice.

Passport Agreement Amendment to Increase Caseload Capacity 08.2013

Providers should complete this amendment to the Passport provider agreement when increasing member caseload capacity.

Passport Provider Change Form 07.2014

Medicaid/HMK Plus members can use this form to change Passport providers. Provider changes will not take effect until the month following the request.

Passport Referral Form 07.2013

Passport providers may use this form when providing a referral for their members to another provider.

Passport to Health Provider Agreement 02.2014

Providers who wish to become a Passport provider should be an active Medicaid provider and have primary care within his/her professional scope of practice.

This agreement is a portion of the Montana Healthcare Programs enrollment package, and the page numbering reflects that document.

W-9 Form 12.2011

This is the approved form to use for Montana Healthcare Programs. Providers must submit a W-9 form when changing their pay-to/1099.

Medicaid Rules and Regulations

Other Resources

Passport Provider Satisfaction Survey 2014

Medicaid Covered Services Chart 08.2013

An overview of Medicaid covered services with Passport to Health indicators.

Requirements for a Member Disenrollment Letter 08.2013

Archived Passport Information