Please follow the Enrollment Instructions below to become an electronic submitter for Montana Medicaid.

 

Required Documents for those applying for new Submitter IDs

The following documents are required enrollment documents that must be completed, signed, and returned the MT Medicaid office prior to initiation of electronic claims submission or inquiry.

 

1. MT Medicaid EDI Provider Enrollment Form

 

2. MT Medicaid Electronic Billing Agreement

 

If the links listed above do not work properly, please download the forms from here:
https://edisolutionsmmis.portal.conduent.com/gcro/mt-enroll

 

If you are a billing service, software vendor, or clearinghouse needing to submit electronic claims on behalf of your providers or you have any questions regarding any of the documents in this package, please call the MT Medicaid EDI Technology Support Center at 1-800-987-6719 for assistance

 

We can now process 276/277 requests (claim status). If this is a transaction you would like to utilize please make sure to enroll with the payer.

 

 

EDI Provider Enrollment Form

(please skip the Authorization form)

Section 1: Classification

• Please select either "Individual Provider" or "Group Provider"

Section 2: Submission Method

• Please check the box for "Asynchronous"

Section 3. Provider Information

• Please enter your Business and/or Provider Name

• Please enter your Business address, City, State, and Zip Code

• Please enter your phone and fax number

• Please enter your Provider Number and your Tax ID

• Please enter your email address

Section 4 & 4a: Montana Submitter ID

• Please leave both sections blank

Section 5: Contact Information

• Please add your contact name and title, then enter the same contact information from Section 3

• If available, please add an alternate contact

Section 6: Provider using Vendor

• Please skip this entire page. You will be a direct Submitter, not using a vendor/billing service/clearinghouse

Section 7: Transaction Sets
Please skip Sub-Section 7a. Then select the following in 7.b:

• 837P - For Professional Claims (CMS 1500)

• 837I - For Institutional Claims (UB04)

Section 8:

• Please skip this section

Section 9:

• Please check the boxes for X12N 999 and X12N 277CA

Section 10:

• Please skip this page

 

Montana Medicaid Trading Partner Agreement

• Please enter your NPI, sign, date, then print your name, title and address

 

Submitting your Forms

It is recommended that you keep a copy of all the forms you will be submitting for your records. Mail the original trading partner agreement and EDI Enrollment forms reflecting original signatures to:

Conduent EDI Solutions
Attn: MT EDI
P.O. Box 4936
Helena, MT 59604

Or Fax to 406-442-4402

It is very important that you complete and return the entire enrollment packet as described above. Incomplete packets will not be processed and will be returned to the submitter.

 

Waiting for a Response

Once the complete provider enrollment packet has been received, the documents will be processed. Processing will take approximately two to three weeks from the date of receipt. (Remember that mailing time can take as much as five days.)

 

After processing, a confirmation will be sent to you as notification to begin filing claims electronically. If neither confirmation nor a returned packet is received after three weeks, please contact the MT Medicaid EDI Technology Support Center at 1-800-987-6719.

 

Testing

Once you have received your Submitter ID and Password from MT Medicaid, please call the SolAce Support Team at 602-439-2525 and set an appointment for a Mailbox setup and Test Transmission to MT Medicaid.

 

Please have 25 test claims ready for testing. Test files should consist of a variety of claims that represent the type of claims you will be submitting once production status is achieved. Test claims will not be processed for payment but will be validated against production files; therefore, they must contain valid patient procedure, diagnosis, and provider information.