Montana Application Service Provider Agreement
Description
How to fill out Application Service Provider Agreement?
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FAQ
Visit the Montana Healthcare Programs Provider Information website to access your provider type page. Choose Resources by Provider Type in the left-hand menu.
If you are dissatisfied with an agency decision you may appeal the decision in writing to: The Department of Public Health and Human Services (DPHHS) Hearing Officer, PO Box 202953, Helena, Montana 59620, or telephone, 406-444-2470 (Voice/TDD) within 45-days of the date you are notified of the decision.
Q. Can I use my Medicaid coverage in any state? A: No. Because each state has its own Medicaid eligibility requirements, you can't just transfer coverage from one state to another, nor can you use your Medicaid coverage when you're temporarily visiting another state, unless you need emergency health care.
If you have questions on which enrollment type is appropriate for you, contact Provider Relations at (800) 624-3958 or email MTEnrollment@conduent.com.
A Montana Medicaid prior authorization form is used by a physician to get permission to prescribe a drug that requires prior-authorization from Medicaid. The DPPHS provides Medicaid members with basic healthcare services, but sometimes a patient is prescribed medication that is not covered by Medicaid.
Some services may require both Passport referral and prior authorization. If a service requires prior authorization, the requirement exists for all Medicaid members. Prior authorization is usually obtained through the Department or a prior authorization contractor.
Apply for Medicaid in Montana Eligibility: Children are eligible for Medicaid with household income up to 143% of the federal poverty level (FPL), and CHIP with household income up to 261% of FPL. Pregnant women are eligible for Medicaid with household income up to 157% of FPL.
Approximate Monthly Income to Qualify for Montana Medicaid, 2023 Family SizeAdults 19-64Pregnant Women1$1,616$1,9082$2,186$2,5803$2,749$3,2454$3,325$3,9252 more rows