Montana Medicaid — Montana Medicaid (Passport to Health / HELP Plan)
| Program name | Montana Medicaid (Passport to Health / HELP Plan) |
|---|---|
| Provider portal | https://dphhs.mt.gov/MontanaHealthcarePrograms |
| FFS claims payer ID | No single canonical ID — routing is fiscal-intermediary-specific. Verify per clearinghouse. |
| Medicaid timely filing | 365 days from date of service |
The federal ceiling for Medicaid timely filing is 12 months under 42 CFR §447.45; most states set a shorter window. Always verify the current policy on the Montana Medicaid provider portal before filing a late-billing appeal.
BCBS licensee in Montana
The Blue Cross Blue Shield Association licensee in Montana is Blue Cross and Blue Shield of Montana (HCSC). This licensee is not yet in the QuickIntell payer registry. See the full payer directory or the BCBSA national site for a provider-portal link.
Top commercial payers in Montana
The dominant commercial insurers operating in Montana, in approximate order of lives covered. Click through for per-payer claims payer IDs, timely filing windows, prior-authorization rules, and appeal procedures.
Medicaid MCOs in Montana
Montana Medicaid MCO data has not yet been populated in the registry.
Medicare contractor and active LCDs in Montana
Noridian Healthcare Solutions, LLC is the Medicare A/B MAC for Montana: Part A and Part B fee-for-service claims from Montana go to it, and its Local Coverage Determinations decide local medical necessity. Durable medical equipment and supply claims go to Noridian Healthcare Solutions, LLC as the DME MAC. Home health and hospice claims are processed by CGS Administrators, LLC. In the current Medicare Coverage Database export, 172 active LCDs from these contractors apply to Montana claims.
- Noridian Healthcare Solutions, LLC
A/B MAC (Part A and Part B claims); DME MAC (durable medical equipment and supplies)
- CGS Administrators, LLC
Home health and hospice MAC
Selected active Noridian Healthcare Solutions, LLC policies for Montana
A selection, not the full list: policies with measured search demand come first, then those on topics that more contractors publish LCDs for.
- L38814 MolDX: Minimal Residual Disease Testing for Cancer
- L39240 Epidural Steroid Injections for Pain Management
- L38902 Wound and Ulcer Care
- L34211 Trigger Point Injections (TPI)
- L35526 B-type Natriuretic Peptide (BNP) Testing
- L38709 Computed Tomography Cerebral Perfusion Analysis (CTP)
- L40255 Temporary Nontherapeutic Ambulatory Cardiac Monitoring Devices
- L34194 Blepharoplasty, Eyelid Surgery, and Brow Lift
- L34215 Lab: Flow Cytometry
- L35136 Spinal Cord Stimulators for Chronic Pain
- L36538 Treatment of Males with Low Testosterone
- L36678 Lab: Bladder/Urothelial Tumor Markers
Equipment, home health and hospice policies that apply in Montana
- L33822 Glucose Monitors
- L33789 Power Mobility Devices
- L33318 Knee Orthoses
- L33686 Ankle-Foot/Knee-Ankle-Foot Orthosis
- L33718 Positive Airway Pressure (PAP) Devices for the Treatment of Obstructive Sleep Apnea
- L33792 Wheelchair Options/Accessories
- L33797 Oxygen and Oxygen Equipment
- L33942 Physical Therapy - Home Health
Steps to confirm which LCD governs a claim · Every active LCD by contractor
State-specific regulations affecting Montana billing
- MCA §33-36-109 / SB 44 of 2017 (Montana Out-of-Network Billing Protections)
- MCA §33-18-232 (prompt pay — 30 days electronic clean claim)
- MCA §50-5-121 (hospital community benefit / charity care)
Provider licensing & enrollment in Montana
Providers enroll via Montana Healthcare Programs Provider Enrollment (Conduent). HELP Plan claims administered by BCBSMT as TPA.
Major health systems headquartered in Montana
| Health system | Headquarters |
|---|---|
| Billings Clinic | Billings, MT |
| Bozeman Health | Bozeman, MT |
| Providence St. Patrick Hospital | Missoula, MT |
| Benefis Health System | Great Falls, MT |
| Logan Health | Kalispell, MT |
Frequently asked questions — Montana billing
What is the Montana Medicaid program called?
Montana's Medicaid program is known as Montana Medicaid (Passport to Health / HELP Plan). Providers enroll and manage claims through the provider portal at https://dphhs.mt.gov/MontanaHealthcarePrograms.
What is the Montana Medicaid timely filing limit?
Montana Medicaid (Passport to Health / HELP Plan) requires initial claims to be filed within 365 days from the date of service. The federal ceiling is 12 months under 42 CFR §447.45; Montana's 365-day window is set by the state provider manual. Late-billing exceptions may be allowed with good-cause documentation — verify on the state portal before filing an appeal.
Does Montana Medicaid publish a single claims payer ID?
No single canonical claims payer ID is published for Montana Medicaid (Passport to Health / HELP Plan). Claims route through the state's fiscal intermediary; look up the correct submitter ID in your clearinghouse directory (Availity, Change Healthcare/Optum, Waystar) and route managed-care claims by the member's MCO assignment.
Who are the largest commercial insurers in Montana?
The dominant commercial payers in Montana include UnitedHealthcare, Aetna, Cigna, Humana, Providence Health Plan, along with the BCBS licensee Blue Cross and Blue Shield of Montana (HCSC). Each payer's claims routing, timely filing, and prior-auth rules differ — see the per-payer guides linked above.
What Medicaid managed-care organizations operate in Montana?
Montana Medicaid MCO data has not yet been populated in the registry. Consult the state Medicaid portal for the current MCO roster.
What state-specific billing regulations apply in Montana?
Montana has 3 tracked state-level statutes that affect medical billing and RCM: MCA §33-36-109 / SB 44 of 2017 (Montana Out-of-Network Billing Protections); MCA §33-18-232 (prompt pay — 30 days electronic clean claim); MCA §50-5-121 (hospital community benefit / charity care). These sit on top of federal protections such as the No Surprises Act, HIPAA, and 42 CFR §447.45.
Run cleaner claims in Montana with QuickIntell
QuickRCM, QuickAuth, and QuickERA are tuned to Montana Medicaid (Passport to Health / HELP Plan) and the commercial payers on this page — eligibility, prior auth, claim scrubbing, and ERA posting all run on real payer rules, not generic adapters.
Disclaimer
This page is operational reference for medical-billing professionals. It is not legal, clinical, or contractual advice. State Medicaid policies, MCO contracts, and payer rules change without notice — always verify against the current provider manual from Montana Medicaid and the member ID card before submission.