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Passport to Health

Passport Publications

Passport to Health Manual 01/2019
Everything a provider needs to know to become a successful Passport provider.
What Is Passport 01/2019

Provider Notices

Some documents on this page are legal and/or historical in nature and cannot be altered to meet 508 Accessibility standards. Each of those documents has a corresponding .txt document with the same name placed next to it.

2019

11/15/2019 Chronic Care/Coordinated Care Codes Revised

08/22/2019 Managed Care Referrals

2018

04/04/2018 Updated Passport Eligible Populations & Reimbursement

Passport Forms

Passport Agreement Amendment to Increase Caseload Capacity 01/2019

Providers should complete this amendment to the Passport provider 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 month following the request.

Passport Referral Form 01/2019

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

Passport to Health Provider Agreement 01/2019

Providers who wish to become a Passport provider should be an active Medicaid provider and have primary care within his/her professional scope of practice.

This agreement is a portion of the Montana Healthcare Programs enrollment package, and the page numbering reflects that document.

Primary Care Case Management Agreementt 03/2019

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

W-9 Form 12/2011

This is the approved form to use for Montana Healthcare Programs/ Providers must submit a W-9 form when changing their pay-to/1099.

Member Disenrollment Letter 12/2019