Welcome to the Montana Healthcare Programs
Provider Information Website.
CMS Issues Fax Scam Alert
June 30, 2025
The Centers for Medicare and Medicaid Services (CMS) is warning providers about a rise in phishing scams involving fraudulent fax requests for medical records. These fax scams are typically unexpected, threatening, and requires an urgent response.
If you receive a request and suspect it may be a scam:
- Do not respond directly through any links, phone numbers, or fax numbers in the request.
- Independently verify the sender.
- Report any suspicious requests immediately to the Surveillance Utilization Review Section (SURS) at HHSOIGSURS@mt.gov or Provider Relations Helpdesk at 800-624-3958.
While these scams can come in any form, CMS has shared a couple of examples.
Example #1
Example #2
Revalidation List Updated
June 27, 2025
Provider Revalidation List
Claims System Modernization - New Montana Healthcare Programs Claims System Coming in 2027
April 4, 2025
The Department of Public Health and Human Services is pleased to announce we have contracted with Gainwell Technologies to implement a new system for processing and paying Montana healthcare claims. The claims project kicked off in October 2024, with plans to roll out the new system in 2027. For more information and to subscribe to receive updates to your inbox, please visit Claims Modernization on the DPHHS website.
Update to Member Eligibility Faxback Requests
April 3, 2025
Montana Healthcare Programs has updated the eligibility Faxback requests process. The fax line for direct requests (800) 714-0075 is no longer active. The new Faxback process is now integrated with the IVR system, (800) 624-3958. To request the eligibility Faxback, select the option for eligibility then enter the required provider and member information. The option to receive a Faxback will be made available after the eligibility information is announced.
If there are further questions on this new process, please contact Provider Relations MTPRHelpdesk@conduent.com or call the support line.
EFT Authorization Agreement Updated
February 7, 2025
The Electronic Funds Transfer (EFT) Authorization Agreement form has been revised to provide clarification for providers on the address type accepted. Providers must include the street address, city, state and ZIP+4. A post office box address is not accepted.
In addition, a new option has been added in the Reason for Submission section. If you are submitting the EFT as part of your revalidation process, choose the Providing Current Information option and in the Reason for providing field, indicate Revalidation. Complete the form as applicable.
The revised EFT Authorization Agreement is posted on the Forms page of the Montana Healthcare Programs Provider Information website under the Forms D – F tab.
Error in Pharmacy Pricing File
January 30, 2025
The department has identified an error in the pharmacy pricing file, and thousands of incorrect rates were loaded. The department is actively working to get the correct rates loaded into the system and anticipates rates will be corrected within a week. Once corrected, the department will process a mass adjustment of all impacted claims and correct the claims. No action is required by the pharmacy.
Provider Resources Information Updated
January 10, 2025
Information on the Montana Healthcare Programs Provider Information website under Resources by Provider Type on the Select Your Provider Type page has been updated.
Changes affecting Substance Use Disorders providers are as follows:
1. Under Select your Provider Type, the resource titled Chemical Dependency has been deleted.
2. A new entry has been added for Substance Use Disorders.
3. When you click on the Substance Use Disorders provider type link, you are taken to the same resource page that had been titled Chemical Dependency and is now updated to Substance Use Disorders.
Revalidation Requirements Deadline
December 23, 2024
Montana Medicaid providers are being urged by the Department of Public Health and Human Services (DPHHS) to update their enrollment information by Dec. 31, 2024 to ensure uninterrupted payment reimbursement.
DPHHS officials state this is a federally required step, known as the provider revalidation process, in order for providers to continue participating in Montana Medicaid.
This deadline affects over 1,400 Medicaid providers across the state who have yet to update their information. To date, over 8,400 providers have successfully completed the process.
Providers who fail to complete the necessary updates by the Dec. 31 deadline risk having their payments suspended.
Providers can review their current revalidation status on the Medicaid provider website and the Provider Services Portal. The revalidation process takes approximately 50 minutes to complete.
Montana Medicaid providers are required to verify and update their enrollment information every five years to remain eligible for participation in Montana Medicaid. Note that this process is unrelated to the recent PHE redetermination process that verified the eligibility of approximately 330,000 Montanans enrolled in Medicaid at the time.
Providers can check their revalidation status by reviewing the current provider revalidation list on the Medicaid provider website or by logging into the services portal.
The revalidation menu option will be active. Providers should ensure all necessary steps are completed and the revalidation is in a submitted status.
For more information about the provider revalidation process visit MedicaidProvider.mt.gov to access resources by provider type, provider notices, and Claim Jumper articles. The Revalidation User Guide is also available.
In addition, DPHHS has added bi-weekly revalidation seminars with dates posted online. For technical issues completing revalidations, contact MT Provider Relations at MTPRHelpdesk@Conduent.com or call 1-800-624-3958 and select revalidation for assistance.
Provider Revalidation List
Revalidation Training Video
2024 W-9 Form Required
October 15, 2024Department of Administration is no longer accepting prior versions of the W-9 forms. All W-9 forms must have 2024 on the top, left-hand corner. All enrollments and updates that are not approved as of 10/15/2024 that required a W-9 form will need a revised W-9 if the version is not 2024. The current W-9 form is on the Forms page of this website in the Forms P-Z tab.
Revalidation Requirements Deadline
October 11, 2024The Department of Public Health and Human Services (DPHHS) has resumed Provider Revalidation post the COVID 19 Public Health Emergency. Provider Revalidation is a federally required compliance measure for providers to verify and update their enrollment information every five years to remain eligible for participation with Montana Healthcare Programs. Currently there are many providers that have not completed their revalidations. Failure to complete overdue revalidations by December 31, 2024, will result in suspended payments. Failure to complete overdue revalidations by December 31, 2024, will result in suspended payments.
Providers should review the current Provider Revalidation List on the Provider Information website to check their revalidation status. Providers may also review their Correspondence History on the MPATH Provider Services Portal. Montana Healthcare Programs sent notification letters beginning August 2023 to the address on file 90 days before the revalidation due date.
Free Virtual Provider Training Opportunity for Members with Intellectual and Developmental Disabilities
October 4, 2024In partnership with the Montana Developmental Disabilities Program (DDP), the Montana Department of Public Health and Human Services (DPHHS) is making a free training opportunity available for Medicaid providers interested in better understanding the special healthcare needs of members with intellectual and developmental disabilities (IDD).
Participants may earn Continuing Medical Education (CME) or Continuing Education Unit (CEU) credits through the self-paced, virtual training. For details on the training course, refer to the IDD Healthcare eLearn Course Information Flyer.
Registration is open to physicians, nurse practitioners, nurses and physician assistants. Providers may register through Montana Curriculum in IDD Healthcare eLearn Course Registration on the IntellectAbility website.
The training is available for up to 500 attendees on a first-come first-serve basis. Seats are also being held for students in the health and human services and/or medical fields.
Attention: Providers Partnered with Change Healthcare Can Resume Electronic Claims Submission to Montana Healthcare Programs
May 9, 2024Change Healthcare has re-established their connection with Montana Healthcare Programs. Providers can resume sending claims via their standard practice prior to the Change Healthcare cyberattack. If you are submitting claims and continue to experience issues, please reach out through your biller to connect with the Change Healthcare resources. For more information, please see reference to Montana Medicaid at https://www.unitedhealthgroup.com/changehealthcarecyberresponse#latestupdates.
Claims Processing Delays
November 9, 2023 The Department is working with Conduent to address claims processing delays due to staffing shortages. Department staff are actively evaluating common edits that cause claims to suspend and making procedural and system changes to streamline claims processing. Changes to the 40-year-old claims system are challenging; however, as opportunities for automation are identified, they are prioritized for development and implementation. Additionally, Conduent has added numerous staff resources to expedite claims processing. Finally, the State Medicaid Director, Mike Randol, meets with Conduent executive leadership weekly to ensure continued progress toward resolving the claims processing delays.
Claims Payment Discrepancy Update
September 15, 2023On September 13, 2023, the Department of Public Health and Human Services (DPHHS) identified a claims payment issue with the September 11, 2023, payment cycle. The cause of this issue was that the payment file for August 14, 2023, was re-run and providers received their August 14, 2023 payments again in error instead of the payments they should have received on September 11, 2023.
To correct this issue, this weekend, the Department, will reverse the EFT payments or cancel the warrants that providers received in error, and process the proper payments due to providers for September 11, 2023.
The remittance advices providers received on September 11, 2023, will match the corrected payments providers will receive on or before Tuesday September 19, 2023. Providers should use the remittance advices received on September 11, 2023, for reconciliation purposes. The only item that will not match is the warrant number for the corrected payment.
Providers will receive their payments as usual for September 18, 2023.
Impacted providers will also receive a notification to their email on file. The Department sincerely apologizes for this issue and has taken immediate steps to prevent this issue from re-occurring in the future.
Claims Payment Discrepancy Identified
September 13, 2023The Department of Public Health and Human Services (DPHHS) has identified a claims payment issue with the September 11, 2023 payment cycle. The issue has caused under payments or overpayments to some providers. Impacted providers will note that their deposit information does not match their 835s or Statement of Remittance (SOR). We are diligently working to identify impacted payments and are taking steps to reconcile and resolve the issue. Updates will be provided as soon as information becomes available.
For claims questions or additional information, contact Montana Provider Relations at (800) 624-3958 or (406) 442-1837 or email Montana Provider Relations Helpdesk.
Visit the Montana Healthcare Programs Provider Information website to access your provider type page. Choose Resources by Provider Type in the left-hand menu.
Information Reminder
Providers are able to access information 24/7 by calling Provider Relations at (800) 624-3958.
When the system answers, Providers choose Option 7. Option 1 is for pharmacies requesting unlock and Option 5 is for members.
OPTION 1: Last 5 PAYMENTS
OPTION 2: CLAIMS STATUS
OPTION 3: MEMBER ELIGIBILITY
OPTION 4: PROVIDER ENROLLMENT SUPPORT
OPTION 5: VALIDATE PROVIDER NUMBER
OPTION 6: GET EDI HELP
OPTION 7: WEB PORTAL PASSWORD RESET
We appreciate the work you do at all hours of the day and night to serve Montana Healthcare Program members. The IVR is there to help you get the information you need when you need it.
Online Training Available
Loma Romero, Provider Relations Field Rep, Conduent, Second Wednesday of every month at 10am Mountain Time (1 Hour)
• These trainings will be on the second Wednesday of every month at 10am. Providers must register for each occurrence they wish to attend.
• This is a general enrollment training not a series of trainings.
General Resources
Loma Romero, Provider Relations Field Rep, Conduent, July 17, 2025 at 2pm Mountain Time (1 Hour)
• How to read remittance advice.
• General website resources.
• How to fill out an individual adjustment request form.
Billing 101
Loma Romero, Provider Relations Field Rep, Conduent, July 23, 2025 at 10am Mountain Time (1.5 Hours)
Monthly General Resources
Maria Gonzales, Provider Relations Field Rep, Conduent, First Wednesday of every month at 10am (MT) August 6th (1 Hour)
• Website Navigation
• Where to find forms & training material
• How to fill out an individual adjustment request form
• How to read a remittance advice
CSCT
Monthly Billing 101
Maria Gonzales, Provider Relations Field Rep, Conduent, Fourth Wednesday of every month at 10am (MT) August 27th (1 Hour)
• Website Navigation
• Where to find forms & training material
• How to fill out an individual adjustment request form
• How to read a remittance advice
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