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:

• Provider Relations Fax:
  (888) 772-2341
• FaxBack
  (800) 714-0075

Email:

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 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) 

Department of Public Health and Human Services (DPHHS) https://dphhs.mt.gov/

To locate your program officer, see the Division entry on the webpage, Public Health and Human Services, Department of (mt.gov) or contact your Program Officer by calling the telephone number indicated below.

• Adult Mental Health – (406) 444-3964
• Ambulance – (406) 444-3182
• Ambulatory Surgical Centers – (406) 444-3995
• Applied Behavior Analysis Services – (406) 444-3878
• Audiology – (406) 444-4518
• Children’s Mental Health
  Comprehensive School and Community Treatment (CSCT) – (406) 444-5916
  Youth Mental Health Services – (406) 444-6018
  • Services include:
    Acute Youth Mental Health
    Psychiatric Residential Treatment Facility (PRTF)
    Partial Hospital Services (PHP)
    Therapeutic Group Home (TGH)
    Home Support Services (HSS)
    Therapeutic Foster Care (TFC) and TFC- Permanency
    Day Treatment
    Outpatient Therapy Youth Mental Health
    Targeted Case Management for youth with SED
    Community Based Psychiatric Rehabilitation and Support Services (CBPRS)
• Developmental Disabilities Program (0208 Waiver and TCM Services) – (406) 444-3072
• Dental (Dentist, Denturist, Dental Hygienist, Oral Surgeon) – (406) 444-3182
• Dialysis Clinics – (406) 444-7018
• Durable Medical Equipment (DME) – (406) 444-4518
• EPSDT (Private Duty Nursing, Chiropractic, Milk Bank, Nutritionists) – (406) 444-4349
• Eyeglasses – (406) 444-4066
• Family Planning Clinic – (406) 444-3995
• Federally Qualified Health Center (FQHC) – (406) 444-7018
• Healthy Montana Kids (HMK) – (406) 444-6002
• Hearing Aid Dispensers – (406) 444-4518
• Home Infusion Therapy – (406) 444-2738
• Hospitals – (406) 444-7002
• Independent Diagnostic Testing Facilities – (406) 444-3995
• Indian Health Service (IHS) / Tribal 638 / Urban Indian Organization (UIO) – (406) 444-1292
• Laboratory Services – (406) 444-3995
• Mid-Level – (406) 444-3995
• Mobile Imaging – (406) 444-3995
• Non-Emergency Medical Transportation – (406) 444-3182
• Optometric – (406) 444-4066
• Pharmacy – (406) 444-2738
• Physicians – (406) 444-3995
• Podiatrist – (406) 444-3995
• Public Health Clinics – (406) 444-3995
• Rural Health Clinic (RHC) – (406) 444-7018
• School-Based Services – (406) 444-4066
• Substance Use Disorder – (406) 444-3964
• Targeted Case Management (High-Risk Pregnancy, Children and Youth with Special Health Care Needs) – (406) 444-4349
• Therapy (Occupational, Physical, and Speech Therapy) – (406) 444-4066
• Transportation – (406) 444-3182

Mountain Pacific

Transportation Utilization Review:
Call Center:      (800) 292-7114                                                    
Address:           PO Box 6488
                       Helena MT 59604-6488

For members requesting travel reimbursement prior authorization for driving themselves or if a family member/friend is driving them to an approved medical appointment, sign into the Montana Medicaid Transportation Request Portal to complete your travel request prior to your medical appointment. 


Pharmacy Utilization Review:
Call Center:       (800) 395-7961
                        (406) 443-6002

Fax:                  (800) 294-1350
                        (406) 513-1928

Physician Administered Drugs:
Call Center:      (800) 219-7035
Address:           PO Box 5119
                       Helena MT 59604

All Other Utilization Reviews:
Call Center:       (800) 219-7035
Address:            PO Box 5119
                        Helena MT 59604

Website: Mountain Pacific Provider Portal

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

Administrative Rules of Montana https://rules.mt.gov/

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 Dental Association http://www.ada.org/en/

A leading source for oral health-related information for dentists and their patients.

Member Service Center
(877) 773-2969 (Weekdays: 8 a.m. to 5 p.m. Central Time)
(312) 440-3542 Fax
catalog@ada.org

Send written inquiries to:
American Dental Association
211 East Chicago Avenue
Chicago, IL 60611

Blue Cross Blue Shield of Montana: http://www.bcbsmt.com

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.

Tracks and investigates public health trends. http://www.cdc.gov/

An agency within the U.S. Department of Health and Human Services responsible for administration of several key federal health care programs. http://www.cms.gov/

Crime Victim Compensation https://dojmt.gov/victims/crime-victim-Compensation/

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

Health Resources Division https://dphhs.mt.gov/hrd

Dental program

For program policy questions:
(406) 444-3182 Phone
(406) 444-1861 Fax
HHSMedicaidDental@mt.gov

Send written inquiries to:
Dental Program Officer
P.O. Box 202951
Helena, MT 59620-2951

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:

Send written inquiries to:
Indian Health Service (IHS) / Tribal 638 / Urban Indian Organization (UIO) Program Officer
Health Resources Division
PO Box 202951
Helena, MT 59620

List of Excluded Individuals/Entities (LEIE) https://dphhs.mt.gov/MontanaHealthcarePrograms/TerminatedExcludedProviders.aspx

Passport to Health, Team Care, Nurse First, and Health Improvement Program
https://dphhs.mt.gov/MontanaHealthcarePrograms/MedicalPrograms

Adult and children mental health services information for Medicaid and MHSP.
https://dphhs.mt.gov/bhdd/mentalhealthservices/index

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
 

Member Information https://dphhs.mt.gov/MontanaHealthcarePrograms

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

Montana Code Annotated (MCA)  http://leg.mt.gov/bills/mca_toc/53_6_1.htm

Mountain Pacific

Transportation Utilization Review:
Call Center:      (800) 292-7114
Address:           PO Box 6488
                        Helena MT 59604-6488

For members requesting travel reimbursement prior authorization for driving themselves or if a family member/friend is driving them to an approved medical appointment, sign into the Montana Medicaid Transportation Request Portal to complete your travel request prior to your medical appointment. 


Pharmacy Utilization Review:
Call Center:       (800) 395-7961
                        (406) 443-6002

Fax:                  (800) 294-1350
                        (406) 513-1928

Physician Administered Drugs:
Call Center:      (800) 219-7035
Address:           PO Box 5119
                        Helena MT 59604

All Other Utilization Reviews:
Call Center:       (800) 219-7035
Address:            PO Box 5119
                        Helena MT 59604

Website: Mountain Pacific Provider Portal

National Correct Coding Initiative https://www.medicaid.gov/medicaid/program-integrity/ncci/index.html

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/

Medicare Part B Carrier. https://www.noridianmedicare.com/

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

Email: HeatherSmith@mt.gov

(406) 444-4171

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

• 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

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. 

System for Award Management: https://sam.gov/content/home

For questions regarding the Team Care Program:

(406) 444-4349 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