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