Contact Provider Relations for general claims questions, questions about enrollment, eligibility, Passport, Medicaid, MHSP, HMK pharmacy, eyeglass and dental payments and denials:
Telephone:
(800) 624-3958 In/Out of state
(406) 442-1837 Helena
IVR (24/7 verify member eligibility, payments, enrollment status etc) (800) 362-8312
Fax:
(406) 442-4402 Fax
FaxBack (800) 714-0075
Email:Provider
Enrollment - MTenrollment@conduent.com
Provider Relations - MTPRHelpdesk@conduent.com
US Mail:
Send written inquiries to:
Provider Relations Unit
PO Box 4936
Helena, MT 59604
Note:
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.
On the next menu, select one of the following options:
OPTION 1: Last 5 PAYMENTS
OPTION 2: CLAIMS STATUS
OPTION 3: MEMBER ELIGIBILITY
OPTION 4: PROVIDER APPLICATION STATUS
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. (posted 08/16/2019)
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
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
100 North Park Avenue, Suite 300
PO Box 202905
Helena, MT 59620-2905
(406) 444-3964 Phone
(406) 444-4435 Fax
111 North Sanders, Room 307
PO Box 4210
Helena, MT 59604-4210
(406) 444-4545
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
Send paper claims to the address above. For questions about dental claims, call Provider Relations. For more information, see the HMK website.
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
Send paper claims to the address in Claims above.
For questions about MHSP claims, contact Provider Relations.
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
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
The hospital’s diabetic education protocol must be approved by:
Medicare Part A Program
P.O. Box 5017
Great Falls, MT 59403
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
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
(406) 444-7018 Phone
(406) 444-1861 Fax
FQHC Program
Hospital and Physician Services Bureau
DPHHS
P.O. Box 202951
Helena, MT 59620-2951
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
Critical Access Hospitals – 406-444-4834
FQHC – 406-444-7018
Hospital Programs – 406-444-4834
Rural Health Clinic Program – 406-7018
(406) 1861 Fax Send written inquiries to: Hospital Program Officer
Health Resources Division
DPHHS
P.O. Box 202951
Helena, MT 59620-2951
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
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
Members who have Medicaid questions may call the Help Line, 1 (800) 362-8312.
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) 362-8312
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
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
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
Nurse First https://dphhs.mt.gov/MontanaHealthcarePrograms/NurseFirst.aspx
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.
DPHHS Passport Page: https://dphhs.mt.gov/MontanaHealthcarePrograms/Passport.aspx
Provider Website Page: https://medicaidprovider.mt.gov/passport
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.
Providers who wish to enroll or have Passport questions may also contact the Passport Provider Lead.
PO Box 254
Helena, MT 59624-0254
(406) 457-9542 In/Out of state
(406) 442-2328 Fax
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)
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/
National Plan and Provider Enumeration System (NPPES) https://nppes.cms.hhs.gov/NPPES/
1400 Broadway
PO Box 202951
Helena, MT 59620-2951
(406) 444-3995 In/Out of state
(406) 444-1861 Fax
For program policy questions:
Medicaid Services Bureau
1400 Broadway
PO Box 202951
Helena, MT 59620
(406) 444-4540
(406) 444-1861
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.
For information on presumptive eligibility, see https://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
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
Refer to the Prior Authorization Information and your provider type manual.
OOS Acute & Behavioral Health
Hospital, Transplant, Rehab & PDN:
(406) 457-3060 (Helena) or
(877) 443-4021 (Toll Free)
Fax: (406) 513-1923 Helena or
(877) 443-2580 (Toll Free)
MPQH – DMEPOS/Medical
(406) 457-3060 Helena or
(877) 443-4021
Fax:
(406) 513-1923 Helena or
(877) 443-2580
Magellan Medicaid Administration
Phone: (800)770-3084 (opt 3)
Fax: (800) 639-8982
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.
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
DPHHS Public Health Lab
1400 Broadway
PO Box 6489
Helena, MT 59620
(800) 821-7284 In state
(406) 444-3444 Helena/Out of state
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
(406) 444-7018 Phone
(406) 444-1861 Fax
RHC Program
Hospital and Physician Services Bureau
DPHHS
PO Box 202951
Helena, MT 59620-2951
1100 North Last Chance Gulch
PO Box 4210
Helena, MT 59604-4210
(406) 444-4077
Send written requests to:
Fraud and Abuse
Surveillance/Utilization Review
2401 Colonial Drive
PO Box 202953
Helena, MT 59620-2953
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
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.
Team Care: https://dphhs.mt.gov/MontanaHealthcarePrograms/TeamCare.aspx
For questions about private insurance, Medicare, or other third party liability:
(800) 624-3958 In/Out of state
(406) 443-1365 Helena
(406) 442-0357 Fax
Send written inquiries to:
Third Party Liability Unit
PO Box 5838
Helena, MT 59604
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