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) 714-0060
Fax:
Email:
MTEnrollment@conduent.comUS 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 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. (posted 08/16/2019)
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.
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 https://dphhs.mt.gov/BHDD/BHDDcontact.
The Health Resources Division (HRD) ( https://dphhs.mt.gov/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. https://dphhs.mt.gov/hrd
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
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.
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
Send paper claims to the address above. For questions about dental claims, call Provider Relations. For more information, see the HMK website.
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
Conduent EDI Solutions
https://edisolutionsmmis.portal.conduent.com/gcro/
To apply for this program, contact:
(800) 694-3084
(406) 444-9440
For a HIPP referral, contact your local Office of Public Assistance. Send written inquiries to:
Health Insurance Payment Program
2401 Colonial Drive, Second Floor
P.O. Box 202953
Helena, MT 59620-2953
P.O. Box 202951
Helena, MT 59620-2951
(877) 543-7669 (Toll-free, follow menu)
(877) 418-4533 (Fax, toll-free)
Information on Healthy Montana Kids. https://dphhs.mt.gov/HMK
Critical Access Hospitals – (406) 444-4834
FQHC – (406) 444-7018
Hospital Programs – (406) 444-4834
Rural Health Clinic Program – (406) 444-7018
Fax: (406) 444-1861
Send written inquiries to:
Hospital Program OfficerSend 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
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
https://mtaccesstohealth.portal.conduent.com/mt/general/home.do
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
https://dphhs.mt.gov/hcsd/OfficeofPublicAssistance
24/7 Verification is available via:
FaxBack (800) 714-0075 or
Voice Response (800) 362-8312
https://mtaccesstohealth.portal.conduent.com/mt/general/home.do
M-F, 8am - 5pm MST verification is available via:
(800) 624-3958 In/Out of state
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. The MATH web portal is located at:
https://mtaccesstohealth.portal.conduent.com/mt/general/home.do
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. Provider Website: https://medicaidprovider.mt.gov/
Mountain-Pacific Quality Health
Call Center:
(406) 443-0320 (Helena) or
(800) 219-7035 (Toll Free)
P.O. Box 6488
Helena, MT 59604
Mountain-Pacific Quality Health (MPQH) https://mpqhf.com/corporate/montanans-with-Medicaid/
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/
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
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
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, certification, or to verify eligibility, contact:
Alice Lewis
(406) 731-5774
email: alewis@mt.gov
Refer to the Prior Authorization Information and your provider type manual.
OOS Acute & Behavioral Health
Hospital, Transplant, Rehab & PDN
DMEPOS/Medical, PAD, &
Behavioral Health Reviews
Call Center:
(406) 443-0320 (Helena) or
(800) 219-7035 (Toll Free)
HMK/CHIP Dental and Eyeglass Provider
To enroll as an HMK/CHIP dental provider, contact Provider Relations at (800) 624-3958.
HMK/CHIP Medical Provider
To enroll as an HMK/CHIP medical provider, contact BCBSMT at (800) 447-7828, X 6100.
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
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
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.
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
Montana State Immunization Program
(406) 444-5580
https://dphhs.mt.gov/publichealth/Immunization
Vaccines for Children
https://dphhs.mt.gov/publichealth/Immunization/VaccinesforChildren