Department of Public Health and Human Services

Montana Healthcare Programs Provider Information » Passport to Health

Main Content

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 Publications

Provider Notices

Some documents on this page are legal and/or historical in nature and cannot be altered to meet 508 Accessibility standards.  Each of those documents has a corresponding .txt document with the same name placed next to it.

2015

12/31/2015  PDF  Increase in Passport Caseloads Due to HELP Plan  TEXT Increase in Passport Caseloads Due to HELP Plan
11/03/2015 PDF  Services Exempt from Passport to Health Referral TEXT Services Exempt from Passport to Health Referral

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

To Access Older Documents, Access the Archive Page