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Passport to Health

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Provider Manuals

Passport to Health Manual
Everything a provider needs to know to be a successful Passport provider.

Medicaid Rules and Regulations

Administrative Rules of Montana (ARM)

Passport to Health Waiver Application

42 CFR Part 438 Managed Care

Passport Forms

Passport to Health Agreement 01/2019

Providers who wish to become a Passport provider should complete this agreement to enroll in the program. Providers must be an active Montana Healthcare Programs provider and have primary care within their professional scope of practice.

Passport Amendment to Increase Caseload Capacity 01/2019

Providers should complete this amendment to the Passport to Health Agreement when increasing member caseload capacity.

Passport Provider Change Form 01/2019

Medicaid/HMK Plus members can use this form to change Passport providers. Provider changes will not take effect until the beginning of the month after the request has been processed.

Passport Referral Form 01/2019

Passport providers may use this form when providing a referral for their members to another provider.

Primary Care Case Management Staff Amendment 03/2019

Providers should complete this amendment to the Passport to Health Agreement when adding new providers to a group practice.

Member Disenrollment Form 12/2019

This form is used to remove a member from your caseload for approved reasons.

Requirements for a Member Disenrollment Form 12/2019

Provider Notices