State · MT
Medical billing services in Montana
Short answer
Medical billing services in Montana bill one state payer with a referral rule attached: Montana Healthcare Programs pays every Medicaid claim fee-for-service through Conduent, and most members belong to Passport to Health, so the Passport provider's referral number must be on the claim for most referred services.
A clean claim has 12 months from the date of service or a later retroactive eligibility decision, Healthy Montana Kids medical claims go to Blue Cross and Blue Shield of Montana instead, home visits have needed Netsmart EVV data since July 1, 2024, and the claims system moves to Gainwell in 2027. A Remitwright dedicated biller tracks those rules, serving Montana practices remotely. Rules for other states are on the medical billing services by state page.
Last reviewed by the Remitwright billing team. Editorial policy
Billing in Montana: what's different
The rules below change how a claim is filed and paid in Montana. Each line links to the official page it was read from, and the date at the top of this page is when it was last checked.
| Fact | In Montana | Source |
|---|---|---|
| Medicaid program | Montana Medicaid (Montana Healthcare Programs)Montana Department of Public Health and Human Services (DPHHS) | 1 |
| Fee-for-service portal | Montana Access to Health (MATH) Web Portal | 1 |
| How Medicaid is delivered | No Medicaid health plans | 3 |
| Managed care plans | 4 plansPassport to Health (primary care case management), CPC+ primary care program (primary care case management), Patient Centered Medical Home (primary care case management), Tribal Health Improvement Program (T-HIP) | 5 |
| Medicaid timely filing (fee-for-service) | 12 months from the date of service | 1 |
| Prompt-pay law | MCA 33-18-232, time for payment of claims | 7 |
| NEMT | Modivcare runs Montana Medicaid's travel assistance benefit | 10 |
Montana Medicaid (Montana Healthcare Programs)
Montana Medicaid (Montana Healthcare Programs) is run by the Montana Department of Public Health and Human Services (DPHHS). Fee-for-service claims and provider enrollment go through the Montana Access to Health (MATH) Web Portal1, at mtaccesstohealth.portal.conduent.com. No Medicaid health plans: CMS's 2024 report counts 174,914 of Montana's 213,159 Medicaid enrollees, 82.1 percent, in a managed care arrangement, every one of them in a primary care case management program rather than a plan that pays claims, so Montana Healthcare Programs pays providers fee-for-service through its fiscal agent3. Passport to Health has run statewide under 1915(b) authority since January 1, 1993 with Conduent as enrollment broker and a 45-day choice period, and three smaller primary care programs sit beside it.
Fee-for-service filing limit: 12 months from the date of service, or from the date retroactive eligibility or disability is determined if that is later, for a clean claim to reach Montana Healthcare Programs1. Medicare crossover claims and third-party payer adjustments carry six-month limits in the circumstances the claims page describes, and every problem with a claim has to be resolved inside the twelve months. Paper claims go to Claims Processing, P.O. Box 8000, Helena, MT 59604 unless a manual says otherwise, on the CMS-1500 (21 lines), the UB-04 (40 lines) or the dental form, none of which the Department supplies.
Managed care plans5
- Passport to Health (primary care case management)94,644 members in CMS's 2024 count; the Passport provider's referral number goes on the claim and payment still comes from the state's fiscal agent
- CPC+ primary care program (primary care case management)Voluntary statewide program since January 1, 2018, 48,062 members in 2024
- Patient Centered Medical Home (primary care case management)Voluntary statewide program since January 1, 2016, 32,208 members in 2024
- Tribal Health Improvement Program (T-HIP)Primary care case management entity on tribal reservation areas since July 1, 2024, 19,382 members
Each plan is credentialed separately, has its own portal and its own appeal route. A practice that joins Montana Medicaid through one plan is not in network with the others until each contract is in place.
Commercial payers and the prompt-pay law
Commercial payers active in Montana8: Blue Cross and Blue Shield of Montana (HCSC), PacificSource, Mountain Health CO-OP (listed by CSI as Montana Health Co-op), UnitedHealthcare (small group filings). A Montana practice works to a separate provider manual for each, with its own filing window, corrected-claim process and appeal levels. Verified payer deadlines, each with its source, are in the timely filing limits table.
Clean-claim payment window under MCA 33-18-232, time for payment of claims: 30 days after receipt of a proof of loss to pay or deny a claim, or 60 days when the insurer reasonably asks for additional information or documents7. A late payment carries 10 percent annual interest from the date the claim was due. The section does not define a clean claim and bars a private cause of action based on compliance with it, and its history line runs from 1983 through amendments in 2003 and 2005. Where the statute earns its place is A/R follow-up: a clean claim that outlasts the window is escalated with the statute cited, and interest is requested where Montana law provides it.
NEMT and home care in Montana
Non-emergency medical transportation. Modivcare runs Montana Medicaid's travel assistance benefit: members get a trip ID from Modivcare by calling the 24/7 reservation line, online or through the app, and prior authorization is required for trips over 100 miles one way or 200 miles round trip, out-of-state travel, per diem for meals and lodging, or an attendant's costs10. Personal transportation covers a member, family member or friend driving, commercial transportation covers taxi, bus and rideshare, and specialized transportation covers wheelchair and stretcher vans. Personal mileage under those distances can be requested up to 30 days after the appointment with a provider signature confirming it was attended, and the benefit covers HMK Plus members as well as Medicaid. The NEMT billing in Montana page covers trip documentation, broker claims and reconciliation.
Electronic visit verification. Mandatory for personal care services, home health care services and other applicable home and community-based services, with full EVV compliance required for dates of service on and after July 1, 2024; claims without compliant EVV data are denied11. The state-provided solution is Netsmart's Mobile Caregiver+, launched September 18, 2023, and a provider may use an alternate EVV solution if it meets DPHHS requirements and is certified for use with Montana Medicaid. See home care billing in Montana for waiver programs, EVV exceptions and authorizations.
Rules that change how Montana claims are billed
Claims move from Conduent to Gainwell's new system in 20271
The Montana Healthcare Programs claims page says the state has contracted with Gainwell Technologies to implement a new system for processing and paying Montana healthcare claims, with the project kicked off in October 2024 and rollout planned for 2027. Until then electronic claims go through the MATH Web Portal or the Provider Services Portal, paper claims go to Claims Processing, P.O. Box 8000, Helena, MT 59604, and Provider Relations answers at (800) 624-3958. A practice that stores payer IDs, portal logins and ERA enrollments for Montana Medicaid should expect every one of them to change during the cutover.
A Passport referral number belongs on most claims6
The Passport to Health manual, updated June 2025, describes Passport as the primary care case management program for Standard Medicaid, the HELP Program Medicaid expansion and Healthy Montana Kids Plus, with most eligible members required to enroll and members in nursing homes, on Medicare or in certain waivers ineligible. Most services a member's Passport provider does not deliver need that provider's referral and approval number, recorded in Box 17a of the CMS-1500 or Box 7 of the UB-04; emergency care, dental, mental health, family planning, pharmacy and obstetrical services are among roughly thirty exempt categories. Team Care members follow the same referral rules and are restricted to one pharmacy.
Four primary care case management programs, no health plans4
CMS's 2024 state tables show Montana running four primary care case management arrangements and nothing else: Passport, statewide since January 1, 1993 under 1915(b) authority with mandatory enrollment, Conduent as enrollment broker and a 45-day choice period; CPC+ since January 1, 2018 and the Patient Centered Medical Home since January 1, 2016, both voluntary and statewide under 1932(a); and the Tribal Health Improvement Program, a primary care case management entity on reservation areas since July 1, 2024. Each covers case management only, so every medical, hospital, drug and home care claim is paid fee-for-service by the state.
Healthy Montana Kids claims go to Blue Cross and Blue Shield of Montana12
Healthy Montana Kids, the state's Children's Health Insurance Program, covers eligible children up to age 19 with medical benefits administered through the Blue Cross Blue Shield of Montana provider network, so most HMK medical and mental health claims are billed to BCBSMT rather than to the Medicaid fiscal agent. Applied behavior analysis, ambulance, dental, pharmacy, eyeglasses, durable medical equipment, prosthetics, orthotics and medical supplies, and claims from federally qualified health centers and rural health clinics, go to Montana Healthcare Programs instead. The HMK Evidence of Coverage in force is effective July 1, 2026.
EVV became a hard claim edit on July 1, 202411
DPHHS launched its EVV application on September 18, 2023 with Netsmart's Mobile Caregiver+ as the state-provided solution and set full compliance for dates of service on and after July 1, 2024, after which claims for personal care, home health and other applicable home and community-based services without compliant EVV data are denied. Providers may use an alternate EVV solution if it meets DPHHS requirements and is certified for Montana Medicaid, and the department runs an EVV questions mailbox and a Mobile Caregiver+ support line on Mountain time.
Conduent is the fiscal agent behind every Montana Healthcare Program2
The General Information for Providers manual names Conduent State Healthcare, LLC as the contractor that processes claims for Montana Healthcare Programs, the Mental Health Services Plan, Healthy Montana Kids, pharmacy, dental and eyeglasses, and describes the MATH Web Portal as available around the clock for eligibility verification, claim history and payment status. It cites ARM 37.85.406 for billing, claims processing and payment, including the rule that a provider has 12 months from a retroactive eligibility determination to bill, and ARM 37.85.407 for third party liability, with the Passport chapter requiring that services be provided or approved by the member's designated provider.
Services for Montana practices
Remitwright serves Montana practices remotely, inside the practice management or EHR system the practice already uses. A dedicated biller works the account; nothing is pooled. Each service below explains what that biller does.
- Medical billingClaims worked by one named biller
- CredentialingEnrollment, CAQH and PECOS kept current
- Eligibility verificationCoverage and benefits checked before visits
- Prior authorizationAuths requested, tracked, attached to claims
- Denial managementEvery denial read, worked and appealed
- A/R follow-upUnpaid claims chased before filing limits
FAQ
Questions from Montana practices
What is the Montana Medicaid timely filing limit?
Which Medicaid plans do we contract with in Montana?
How quickly must insurers in Montana pay a clean claim?
Does Montana require EVV for home care visits?
Who arranges Medicaid transportation in Montana?
Where do Montana Medicaid fee-for-service claims go?
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