Medical Billing Services in Montana

The state pays Montana Medicaid claims itself on a fee-for-service basis, so there is no Medicaid health plan to contract with. Healthy Montana Kids uses its own eligibility checks, and claims coordinated with the Indian Health Service follow their own rules.

Montana is the fourth largest state by land area, so critical access hospital coordination, air ambulance billing and long-distance referrals are routine. Tribal health billing needs Indian Health Service coordination, and Blue Cross and Blue Shield of Montana is a major commercial payer.

MCA 33-18-232 requires insurers to pay or deny a claim within 30 days of proof of loss, or 60 days if they ask for more information. Late payments carry 10% annual interest.

When a tribal member is referred from an IHS facility to a provider outside the IHS system, Purchased/Referred Care authorization must come from the tribe's PRC office before the service. Claims sent without it are routinely denied.

Federal law sets the baseline. Since January 2022 the No Surprises Act has kept providers from balance billing Montana patients for most emergency care, and for out-of-network care delivered inside an in-network facility.

Medicare's filing limit is one year from the date of service (42 CFR 424.44). TRICARE also allows one year from the date of service. Private insurers and Medicaid health plans set filing windows by contract, and those windows are not uniform.