ICD-10 … ARE YOU READY?Education to download full color materials. The toolkit includes guidelines that provide you with key assessment and diagnosis information and color-coded

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ICD-10 … ARE YOU READY?In January 2009, the Department of Health and Human Services (HHS) published its final rule on the conversion of the Health Insurance Portability and Accountability Act (HIPAA) standard medical code sets from International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) to International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) and Procedure Coding (ICD-10-PCS). This conversion requirement will take effect October 1, 2013.

On October 1, 2013, medical coding in U.S. health care settings will change from ICD-9 to ICD-10. The transition will require business and systems changes throughout the health care industry.

The first ICD-10-related compliance date is less than two years away. On January 1, 2012, standards for electronic health transactions change from Version 4010/4010A1 to Version 5010. Unlike Version 4010, Version 5010 accommodates the ICD-10 code structure. This change occurs before the ICD-10 implementation date to allow adequate testing and implementation time.

The compliance dates are firm and not subject to change. Preparing now will help you avoid potential reimbursement issues.

CAPSULE NEWSSM IS A SERVICE MARK OF BLUE CROSS AND BLUE SHIELD OF MONTANA. BLUE CROSS AND BLUE SHIELD OF MONTANA IS AN INDEPENDENT LICENSEE OF THE BLUE CROSS AND BLUE SHIELD ASSOCIATION. ®REGISTERED MARKS OF THE BLUE CROSS AND BLUE SHIELD ASSOCIATION, AN ASSOCIATION OF INDEPENDENT BLUE CROSS AND BLUE SHIELD PLANS. LIVE SMART. LIVE HEALTHY.®

IS A REGISTERED MARK OF BLUE CROSS AND BLUE SHIELD OF MONTANA, SERVING THE RESIDENTS AND BUSINESSES OF MONTANA.

Inside This IssueCover Story .......................................................................1• ICD...10 Are You Ready?

Medical Policy ...................................................................5Administrative• Preventive Services - (NEW)Dental• Denosumab (Prolia) - (NEW)• Trastuzumab (Herceptin) - (REVISED)• Dalfampridine (Ampyra) (NEW) Drugs• Temporomandibular Joint Dysfunction (TMD) - (REVISED)Durable Medical Equipment • Vacuum-Assisted Closure of Chronic Wounds (Negative Wound

Pressure Therapy) - (REVISED)Genetic Testing • Cytochrome p450 Genotyping - (REVISED)• Genetic Testing for Tamoxifen Treatment - (NEW)• Genetic Testing for Warfarin Dose - (NEW)• Pharmacogenomic and Metabolite Markers for Patients Treated with

Thiopurines - (NEW)Medicine: Tests • CA-125 - (REVISED)• Detection of Circulating Tumor Cells in the Management of Patients

with Cancer - (NEW)• Gene-Based Tests for Screening, Detection, and/or Management of

Prostate Cancer - (NEW)Medicine: Treatments • Treatment of Tinnitus - (NEW)Radiology • Dynamic Spinal Visualization - (NEW)• Magnetic Resonance Imaging (MRI) of the Breast - (REVISED)Surgery: Procedures • Cochlear Implant - (REVISED)• Femoroacetabular Impingement, Surgical Treatment - (REVISED)• Obstructive Sleep Apnea: Surgical Treatment - (REVISED)• Patent Foramen Ovale (PFO) Closure Devices (REVISED)• Spinal Cord Stimulation - (REVISED)• Hip Resurfacing (REVISED)Therapies• Electrostimulation and Electromagnetic Therapy for the Treatment of

Chronic Wounds (NEW)• Lifetime Rehabilitation Benefit (REVISED)• Physical Therapy (REVISED)• Occupational Therapy (REVISED)• Speech Therapy (REVISED)Vision• Implantation of Intrastromal Corneal Ring Segments - (NEW)• Lenses and Frames After Cataract Surgery - (REVISED)

Regular Business .............................................................4BCBSMT• Childhood Obesity and Diabetes Prevention Kits• County Mental Health Resource Guide Now Online• Free Flu Vaccinations Again Offered• Provider Information is Critical for Our Members• Treatment of Autism Spectrum DisordersFederal Employee Program• 2011 Surgery for Morbid Obesity Update• HEDIS® – An Important Tool to Measure QualityBlueCard• Out-of-State Medical Policy and Precertification/Prior Authorization

Information Available OnlineTriCare/TriWest• TriWest Enhances Secure Online Functions• TriWest Offering Online Claims Correspondence/Webmail• Webinars Offered on TRICARE Programs

Fraud ................................................................................10• “Incident-To” Billing NOT Allowed by BCBSMT

Participating Providers ......................................................12

Fourth Quarter 2010

www.bcbsmt.com

A NEWSLETTER FOR MONTANA HEALTH CARE PROVIDERS

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https://www.bcbsmt.com/Pages/provcapnews.aspx

https://www.bcbsmt.com/Pages/globalhome.aspx

Cover Story

The following information is from CMS and lists basic steps to prepare for Version 5010/ICD-10 by October 13, 2013. More information is available at https://www.cms.gov/ICD10/05a_ProviderResources.asp#TopOfPage.

• Identify your current systems and work processes that use ICD-9 codes. This could include clinical documentation, encounter forms/superbills, practice management system, electronic health record system, contracts, and public health and quality reporting protocols.

• Talk with your practice management system vendor about accommodations for both Version 5010 and ICD-10 codes. Contact your vendor and ask what updates they are planning to make to your practice management system for both Version 5010 and ICD-10, and when they expect to have it ready to install.

• Discuss implementation plans with all your clearinghouses, billing services, and payers to ensure a smooth transition. Be proactive; don’t wait. Contact your payers, clearinghouse, and billing service with whom you conduct business. Ask about their plans for the Version 5010 and ICD-10 compliance, and when they will be ready to test their systems for both transitions.

• Talk with your payers about how ICD-10 implementation might affect your contracts. Because ICD-10 codes are much more specific than ICD-9 codes, payers may modify terms of contracts, payment schedules, or reimbursement.

• Identify potential changes to work flow and business processes. Consider changes to existing processes including clinical documentation, encounter forms, and quality and public health reporting.

• Assess staff training needs. Identify the staff in your office who code or have a need to know the new codes. Coding professionals recommend that training take place approximately 6 months prior to the October 1, 2013, compliance date.

• Budget for time and costs related to ICD-10 implementation, including expenses for system changes, resource materials, and training. Assess the costs of any necessary software updates, reprinting of superbills, training and related expenses.

Happy Holidaysfrom Blue Cross and Blue Shield of Montana and the Health Care Services Department

Wishing you the best in the coming

New Year

Send Comments Or Questions To:

Michael McGuire, EditorBlue Cross and Blue Shield of MontanaP.O. Box 4309Helena, MT 59604406-437-6153 voice406-437-7879 FAX [email protected]

NOTIFY BCBSMT OF CHANGE TO YOUR INFORMATION

Are you moving? Changing your phone number?Please be sure to inform Blue Cross and Blue Shield of Montana about any changes that your patients need to be aware of so we can update our online and printed directories. Email changes to your provider file to [email protected].

[ Fourth Quarter 2010 ] CapsuleNews 2


Medical Policy

Rationale for Benefit AdministrationMedical policy is developed through consideration of peer-reviewed medical literature, FDA approval status, accepted standards of medical practice in Montana, Technology Evaluation Center evaluations, and the concept of medical necessity. BCBSMT reserves the right to make exceptions to medical policy that benefits the member when advances in technology or new medical information become available.

The purpose of medical policy is to guide coverage decisions and is not intended to influence treatment decisions. Providers are expected to make treatment decisions based on their medical judgment. Blue Cross and Blue Shield of Montana recognizes the rapidly changing nature of technological development and welcomes provider feedback on all medical policies.

When using this policy to determine whether a service, supply, or device will be covered, please note that member contract language will take precedence over medical policy when there is a conflict.

Federal MandateFederal mandate prohibits denial of any drug, device, or biological product fully approved by the Federal Drug Administration as investigational for the Federal Employee Program. In these instances, coverage of these FDA-approved technologies is reviewed on the basis of medical necessity alone.

Advanced Member NoticeParticipating providers can have a member complete and sign an Advanced Member Notification form stating that BCBSMT will not cover this service, supply, device, or drug. Refer to the Advanced Member Notification medical policy for more information.

The following new and revised medical policies were approved in October 2010 with the effective date listed in the policy. You may call BCBSMT at 1-800-447-7828 to request a copy.

All medical policies are copyrighted by Blue Cross and Blue Shield of Montana and may not be reproduced in any manner that is inconsistent with Federal Law.

©2010 Blue Cross and Blue Shield of Montana

Medical PolicyAdministrative• Preventive Services - (NEW)

Dental• Denosumab (Prolia) - (NEW)• Trastuzumab (Herceptin) - (REVISED)• Dalfampridine (Ampyra) (NEW)

Drugs• Temporomandibular Joint Dysfunction (TMD) - (REVISED)

Durable Medical Equipment • Vacuum-Assisted Closure of Chronic Wounds (Negative

Wound Pressure Therapy) - (REVISED)

Genetic Testing • Cytochrome p450 Genotyping - (REVISED)• Genetic Testing for Tamoxifen Treatment - (NEW)• Genetic Testing for Warfarin Dose - (NEW)• Pharmacogenomic and Metabolite Markers for Patients

Treated with Thiopurines - (NEW)

Medicine: Tests • CA-125 - (REVISED)• Detection of Circulating Tumor Cells in the

Management of Patients with Cancer - (NEW)• Gene-Based Tests for Screening, Detection, and/or

Management of Prostate Cancer - (NEW)

Medicine: Treatments • Treatment of Tinnitus - (NEW)

Radiology • Dynamic Spinal Visualization - (NEW)• Magnetic Resonance Imaging (MRI) of the Breast -

(REVISED)

Surgery: Procedures • Cochlear Implant - (REVISED)• Femoroacetabular Impingement, Surgical Treatment -

(REVISED)• Obstructive Sleep Apnea: Surgical Treatment (REVISED)• Patent Foramen Ovale (PFO) Closure Devices (REVISED)• Spinal Cord Stimulation - (REVISED)• Hip Resurfacing (REVISED)

Therapies• Electrostimulation and Electromagnetic Therapy for the

Treatment of Chronic Wounds (NEW)• Lifetime Rehabilitation Benefit (REVISED)• Physical Therapy (REVISED)• Occupational Therapy (REVISED)• Speech Therapy (REVISED)

Vision• Implantation of Intrastromal Corneal Ring Segments -

(NEW)• Lenses and Frames After Cataract Surgery - (REVISED)

https://www.bcbsmt.com/medicalpolicies/Pages/Welcome.aspx


Childhood Obesity and Diabetes Prevention Kit

The percentage of overweight children has more than tripled in the last three decades. In Montana, 27.3% of Montana children are obese compared to 30.6% nationally. As such, the incidence of type-2 diabetes has increased significantly.

Childhood is the most crucial time to help kids develop healthy lifestyle habits they can take with them in adulthood. In particular, pediatricians and family practitioners are on the front line in the effort to reduce obesity.

The Blue Cross and Blue Shield Association (BCBSA) recognizes the critical role physicians have in motivating patients to be healthier. To support you in your efforts, we have developed a toolkit that will help you confront the obesity epidemic with your pediatric patients. BCBSA was fortunate to share this vision with the American Academy of Pediatrics and the American Diabetes Association, which were consulted in the development of the toolkit.

Toolkits were provided to Montana pediatricians earlier this summer. For your convenience, we have posted the complete toolkit materials on our website at www.bcbsmt.com. Click on Providers and then Provider Education to download full color materials.

The toolkit includes guidelines that provide you with key assessment and diagnosis information and color-coded BMI charts that can be used to help educate patients.

The toolkit also includes information for parents and patients to make healthier choices, including:

• A brochure on the implications of childhood obesity

• A poster with healthy tips from the Good Health Club that parents and children can read while they’re in your office or waiting room

• Patient Healthy Tip sheets (segmented by age) that help you set goals with your patients and put an action plan in place to help them achieve those goals

• A BMI chart

• Weekly journal sheets patients can use to track their progress between visits

Our hope is to support you in preventing future cases of diabetes by instilling healthy behaviors in America’s youth today.

For more information on childhood obesity, please visit: http://www.cdc.gov/obesity/childhood. If you have questions about the toolkit, email provider relations at [email protected].

County Mental Illness Resource Guide Now Available OnlineThe County Mental Illness Resource guide, published by the Montana chapter of the National Alliance on Mental Illness (NAMI), is now up and running. NAMI Montana developed the Mental Illness County Resource Guide as a general tool for people who live with serious mental illness and their families.

NAMI, the nation’s largest grassroots organization for people with mental illnesses and their families, supports, educates, and advocates for Montanans with severe mental illnesses and their families.

For more information about NAMI Montana and a direct link to the guide, go to http://www.namimt.org/resources/county%20resources.htm.

FREE Flu Vaccinations Again Offered!Traditional adult flu injections or nasal spray for the 2010-11 flu season are again being offered FREE to our customers. Blue Cross and Blue Shield of Montana (BCBSMT) is providing this great benefit in accordance with the no cost sharing portion of the federal health care reform bill.

Please note, however, that we will not pay for the new high-dose flu vaccine called Fluzone, which is designed specifically for people ages 65 or older. This vaccine costs about 2 and 1/2 times as much as the traditional flu shot and has not been proven to provide greater protection against influenza.

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Blue Cross and Blue Shield of Montana remains committed to providing effective immunizations in a cost-effective manner.

For more information about the Fluzone vaccine, you may go to:

http://www.cdc.gov/flu/protect/vaccine/qa_fluzone.htm

Treatment Of Autism Spectrum DisordersSome health plans may now provide a benefit for the treatment of autism, Asperger’s disorder, and pervasive development disorder (PDD) for children under the age of 19.

Benefits are only available if an individual has been screened, evaluated, and diagnosed with an autism spectrum disorder by one of the following BCBSMT participating providers, regardless of whether the child was previously diagnosed with autism, Asperger’s disorder, or PDD by a provider other than one of the providers listed below:

Child Development Center T-214 Fort MissoulaMissoula, MT 59804Phone: 406-549-6413

Quality Life Concepts 215 Smelter Avenue NEGreat Falls, MT 59403Phone: 406-452-9531

STEP (Support and Techniques for Empowering People) 644 Grande Avenue, Suite 1Billings, MT 59101Phone: 406-248-2055

Developmental Educational Assistance Program 2200 Box ElderMiles City, MT 59301 Phone: 406-234-6034

AWARE—Multiple Locations Statewide616 Helena Avenue, Suite 305Helena, MT 59601Phone: 406-449-3120

Once the diagnostic assessment is complete and the assessment has confirmed the diagnosis of autism, Asperger’s disorder, or PDD, a referral is made to one of seven qualified providers to develop and coordinate

a formal treatment plan. Examples of covered services they provide include training, program design and monitoring, and caregiver training.

There are seven agencies in Montana that BCBSMT recognizes as qualified providers:

1. Developmental Educational Assistance Program (DEAP) – Miles City

2. Quality Life Concepts (QLC) – Great Falls3. STEP (Support and Techniques for Empowering

People) – Billings4. Family Outreach – Helena5. Hi-Line Home Programs – Glasgow6. Child Development Center – Missoula7. AWARE – Multiple Locations

Prior authorization, which is recommended to access the benefits for these specific services, may be obtained by calling Customer Service at 1-800-447-7828.

The BCBSMT Medical Policy may be reviewed at www.bcbsmt.com.

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PROVIDER INFORMATION IS CRITICAL FOR OUR MEMBERSBCBSMT members use our online provider directory for the latest information about providers in our networks. The online directory is updated daily compared to printed provider directories that are only distributed once a year. Our Find a Provider website database is one-stop shopping for all of our groups and individual members and is the most-used application on our website.

Keeping this information accurate depends upon having the latest information about your office and providers entered into our systems. If you have a new providers joining or leaving your practice or changes to your location or phone number, email Health Care Services at [email protected] or call 1-800-447-7828, Extension 6100.


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Federal Employee Program 2011 Surgery for Morbid Obesity UpdateFEP has updated its approval process for surgery for morbid obesity. Prior approval is still required for outpatient surgery for morbid obesity. Inpatient surgery requires precertification through APS. Refer to the back of the member’s ID card for more information about prior approval and precertification.

Inpatient or outpatient benefits for the surgical treatment of morbid obesity are subject to the following presurgical requirements:

• A diagnosis of morbid obesity, in which an individual has a body mass index of 40 or more, or an individual with a BMI of 35 or more with comorbidities for a period of two years prior to surgery.

• Patients must be age 18 or older.

• Participation in a medically supervised weight loss program, including nutritional counseling, for at least three months prior to the date of surgery. Note: Benefits are not available for commercial weight loss programs. Nutritional counseling is allowed when billed by a covered provider such as a physician, nurse, nurse practitioner, licensed certified nurse midwife, dietician or nutritionist, who bills independently.

• Preoperative nutritional assessment and nutritional counseling about pre- and postoperative nutrition, eating, and exercise.

• Evidence that attempts at weight loss in a one-year period prior to surgery has been ineffective.

• Psychological assessment of the member’s ability to understand and adhere to the pre- and postoperative program, performed by a psychiatrist, clinical psychologist, psychiatric social worker, or psychiatric nurse.

• Patient has not smoked six months prior to surgery.

• Patient has not been treated for substance abuse for one year prior to surgery.

Inpatient or outpatient benefits for subsequent morbid obesity surgery are subject to the following presurgical requirements:

• All criteria listed above for the initial procedure must be met again.

• Previous surgery for morbid obesity was at least two years prior to repeat procedure.

• Weight loss from the initial procedure was less than 50% of the member’s excess body weight at the time of the initial procedure.

• The member complied with previously prescribed postoperative nutrition and exercise program.

Claims for the surgical treatment of morbid obesity must include documentation that all requirements have been met. If you have questions about the FEP morbid obesity benefit, documentation, precertification, or prior approval, call FEP Customer Service at 1.800.634.3569.

HEDIS® – An Important Tool to Measure QualityHEDIS (Healthcare Effectiveness Data and Information Set) is a set of standardized performance measures developed by the National Committee for Quality Assurance and health care professionals and researchers from across the United States. It is a tool to measure performance on specific aspects of care, which allows comparison of health plans. BCBSMT has been collecting HEDIS data for its managed care plans and for the Healthy Montana Kids program for a number of years.

As the Federal Employee Program (FEP) moves toward health care that is driven by quality, HEDIS rates are becoming more and more important. Aggregated HEDIS rates are used to evaluate the effectiveness of the FEP program’s ability to demonstrate an improvement in preventive health outreach to its members.

HEDIS rates are calculated through health care claims data. The measures to be calculated are:

• Antidepressant Medication Management

• Antidepressant Medication Management

• Breast Cancer Screening

• Cholesterol Management for Patients with Cardiovascular Conditions

• Comprehensive Diabetes Care (Commercial/Medicaid)

• Comprehensive Diabetes Care (Commercial/Medicaid)

• Follow Up After Hosp for Mental Illness

• Follow Up After Hosp for Mental Illness

• Persistence of Beta-Blocker Treatment After a Heart Attack

The chart on the next page shows how BCBSMT scored in comparison to top performers for each measurement category and against all FEP plans. If you have questions or ideas to improve these scores, contact FEP Customer Service at 1.800.634.3569.

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BCBS OF MONTANA

HEDIS 2010 related to 2009

Measure SubMeasure Denominator Numerator Rate FEP All

10th %

25th %

50th %

75th %

90th %

Antidepressant Medication Management Effective Acute Phase Treatment 202 149 74% 68% 58% 60% 64% 66% 70%

Antidepressant Medication Management

Effective Continuation Phase Treatment 202 119 59% 52% 39% 42% 47% 50% 54%

Breast Cancer Screening Total 6069 4329 71% 70% 62% 65% 67% 69% 72%

Cholesterol Management for Patients with Cardiovascular Conditions LDL-C Screening (CMC) 231 190 82% 70% 66% 75% 84% 87% 89%

Comprehensive Diabetes Care (Commercial/Medicaid) HbA1c Testing 964 813 84% 84% 75% 78% 85% 88% 90%

Comprehensive Diabetes Care (Commercial/Medicaid) LDL-C Screening (CDC) 964 676 70% 81% 69% 74% 80% 84% 87%

Follow Up After Hosp for Mental Illness 30-Day Follow-Up 44 36 82% 73% 60% 67% 74% 78% 84%

Follow Up After Hosp for Mental Illness 7-Day Follow-Up 44 24 55% 49% 38% 43% 52% 60% 68%

Persistence of Beta-Blocker Treatment After a Heart Attack Total 20 17 85% 76% 59% 63% 70% 76% 80%

<25% tile ≤25% tile ≤50% tile ≤75% tile Benchmarks From NCQA’s 2010 Quality Compass for PPOs

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BlueCard® Out-of-State Medical Policy and Precertification/Prior Authorization Information Available OnlineBCBSMT has a new online routing tool to access medical policy information for out-of-state members. This tool will route you directly to the other Blue Cross Blue Shield Plan’s website to view medical policy guidelines for an out-of-state member. You may also use this service to verify precertification or prior authorization requirements. To use this tool, you will need the alpha prefix (first three letters of the member’s identification number) located on their ID card to be routed to the appropriate Plan.

The easy-to-find alpha prefixindentifies the member’s Blue Cross and Blue Shield Plan.

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You must have a login ID for our website to access these services. The Medical Policy router is located on the Provider Policies page, and the Precertification/Prior-authorization router is located on the Prior Authorization page.

If you have questions, contact your provider relations representative at HCS-X6100 or call 1-800-447-7828, Extension 6100.

TriCare/TriWest TriWest Enhances Secure Online FunctionsTriWest Healthcare Alliance Corp. and its claims processor, Wisconsin Physicians Service (WPS), continue to enhance the online features of the secure provider portal at www.triwest.com/provider. To register and get instant access to your secure account, go to: http://www.triwest.com/provider/registration.aspx.

Registered users can use the secure website to perform the following functions and streamline their work. In addition, we have created several secure website demonstrations, which can be accessed at: http://triwest.server.tracorp.com/esem/2010tutoriallinks/Review_index.html.

TriWest Offering Online Claims Correspondence/WebmailProviders have shared their desire to correspond electronically with TriWest for resolution of claims issues and inquiries and we listened! TriWest Healthcare Alliance introduced two tools for registered providers – online claims correspondence and Webmail. Available from the secure provider portal, these tools allow registered users to electronically submit claims-specific issues and other general inquiries.

Registered users can use online claims correspondence for appeals, claim checks, and claim reviews. They will be prompted to enter claims-related information (e.g., a beneficiary’s Social Security number and/or claims number). Users also have the ability to electronically upload supporting documentation, if required, to process their claims inquiry, appeal, or review.

Webmail allows users to submit inquiries regarding general secure website topics (e.g., User Administration, Personal Profile, and Eligibility) that don’t necessarily require an immediate resolution.

Registered users can enter the Secure Message Center from the secure provider portal at www.triwest.com/provider by clicking on Send/View Webmail.

*Note: for referral/authorization issues, users should continue to use the TriWest Online Service Center Tool by clicking on Technical Assistance with Submission Requests.

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To take advantage of these exciting new time-saving features, make sure you are registered for the secure provider portal at www.triwest.com/provider/registration. Registered users can also take advantage of the following features:

• Verify patient eligibility

• Research covered benefits and check referral/authorization and medical review requirements for specific codes

• Submit referrals/authorizations online and check their status regardless of how the request was submitted

• Submit claims online and check claim status regardless of how the claim was submitted

• Download remittance advices

• Download claims status reports

• Initiate Electronic Funds Transfer (EFT) – Coming soon!

If you have questions, contact your provider relations representative at HCS-X6100 or call 1-800-447-7828, Extension 6100.

Webinars Offered on TRICARE Programs New to TRICARE? New staff in your office? If so, you and your staff are invited to participate in a TRICARE Provider Webinar on TRICARE 101, TRICARE Behavioral Health 101, or TRICARE vision coverage.

Developed by TriWest Healthcare Alliance Corp. (TriWest), webinars are for busy providers who need to understand the basics of TRICARE programs to administratively care for their TRICARE patients. A webinar is a training session from your own computer with a live instructor. You will join the class on your computer, but you will hear the instructor by joining a conference call on your telephone.

The TRICARE 101 Webinar, which is approximately one hour long, covers a condensed version of the following topics as compared to our full medical/surgical eSeminar and live seminars:

• TRICARE Overview

• TRICARE Programs

• Clinical Programs

• Referrals and Authorizations

• Claims and Reimbursement

• Provider Resources

The TRICARE Behavioral Health 101 Webinar is approximately 90 minutes long and covers a condensed version of the following topics as compared to our full behavioral health eSeminar and live seminars:

• TRICARE/TriWest Overview

• TRICARE Programs/Behavioral Health Benefits

• Clinical Programs

• Referrals and Authorizations

• Claims and Reimbursement

• Provider Resources

The TRICARE vision benefit is approximately one hour long and was developed for vision providers to give a comprehensive review of the TRICARE vision coverage.

For a schedule of upcoming webinars, refer to the “Stay Updated” section of www.triwest.com/provider. Just select your preferred webinar and register. It’s that easy!

COMPLETE OUR SURVEY AND WIN AN I-POD!BCBSMT is conducting is annual provider satisfaction survey. This mail survey is conducted in three waves and the sooner you complete your survey, the sooner you have a chance to win an Apple I-Pod! Look for your survey in the mail today!

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Fraud

“Incident-To” Billing NOT Allowed by BCBSMTOne of the most common complaints received on the BCBSMT fraud hotline is from patients complaining that services received from a nonphysician provider (physician assistant, nurse practitioner) have been billed under the name of a physician in the clinic. The BCBSMT Special Investigations Unit has identified the practice of submitting claims under the wrong provider name and provider ID as the number one problem addressed by the unit. When identified, however, many providers justify the billing as being incident-to services.

The Centers for Medicare and Medicaid (CMS) defines incident-to services as those that are “furnished incident to physician professional services in the physician’s office (whether located within a different office suite or within an organization) or in the patient’s home.” Incident-to billing is an allowable practice when billing Medicare, as long as you meet the specific requirements set forth by Medicare.

BCBSMT, however, does not recognize incident-to billing, but requires that claims be billed under the name of the provider who actually rendered the service.

Your NPI number is the key to prompt payment of claims. Always include this number when submitting claims for BCBSMT members; otherwise, the claims will be returned to you. Providers must submit claims for services under the provider number assigned to them; submitting claims for payment under another provider’s number may be considered fraud as defined under Montana Code Annotated 33-1-1202(1). A provider may not let another provider use their NPI number to submit claims to BCBSMT except as described in the Locum Tenens Policy or Provider-in-Training Policy. Copies of these policies are available at www.bcbsmt.com. (Login and click on Providers and then Provider Policies).

It is important to submit claims for services provided by a nonphysician practitioner under their NPI, since they are subject to a different fee schedule than a physician. This holds true whether the nonphysician provider is supervised by a physician or not.

To submit claims correctly for nonphysician providers:

1. Make sure all providers in your office have obtained an NPI through the National Plan & Provider Enumeration System, and only use their number for services rendered by the treating provider. To register, log on to https://nppes.cms.hhs.gov/NPPES/StaticForward.do?forward=static.npistart

2. Always submit claims using the name and NPI of the provider who rendered the service.

3. Do not use a supervising physician name to submit claims for services rendered by a nonphysician provider, even though those services may be approved by the supervising physician.

Submission of nonphysician claims under a physician name results in increased reimbursement and may be reported to authorities. Reimbursement of overpayments will be pursued when identified. If your office has been billing nonphysician services incorrectly, contact the SIU, and we will work with you to ensure future claim submissions are correct and that any claims processed in error are corrected.

More information about submitting claims can be found in the BCBSMT Provider Manual at www.bcbsmt.com (Click on Providers and then Provider Manuals).

If you have questions or concerns about fraud or questionable practices, call our fraud hotline at 1-800-621-0992, or you may e-mail us at [email protected]. More information is also available on our website at www.stopfraud.bcbsmt.com. _____________________________________________________

Karl Krieger currently serves as a BCBSMT Special Investigator and is a Certified Fraud Examiner and an Accredited Health Care Fraud Investigator. Karl has been employed by BCBSMT for over 21 years, has received the DPHHS Inspector General’s Integrity Award for his work in health care fraud, and has served on the Board of Directors for the Big Sky Chapter of the Association of Certified Fraud Examiners. Karl can be reached at 1-800-447-7828, Extension 5214, or by email at karl_krieger@

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Participating Providers: August 1 to October 31, 2010The following pages list new and terminated providers for the Traditional Participating Provider Network and the Joint Venture Managed Care Provider Network. Note: If a participating provider has changed locations, they received a new effective date and are listed below.

Blue Cross and Blue Shield of Montana welcomes these new participating providers to its Traditional Network.

Kathy J. Adams Polson Speech Therapy

Mohamad A. Al-Hafez Miles City Internal Medicine

Katharine C. Althans Ennis Chiropractic

Jonathan C. Anderson Kalispell Anesthesiology

Valerie L. Anderson Great Falls Nurse Practitioner

Jennifer G. Andrus Billings Ear, Nose, and Throat

Diane L. Arkava Billings Licensed Clinical Social Worker

Marsha L. Atherton Cut Bank Family Medicine

Jessalyn K. Bahnmiller Great Falls Physical Therapy

Mae D. Baltazar Livingston Physical Therapy

Esther S. Barnes Kalispell Podiatry

Brian K. Barstad Libby Family Medicine

Ashley A. Basten Helena Internal Medicine

Aldo A. Battiste Helena Radiology

Jace A. Bird Great Falls Family Medicine

Jace A. Bird Fort Benton Family Medicine

Amanda J. Blea Polson Family Medicine

Maria C. Borchert Hamilton Physical Therapy

Sarah N. Borge Missoula Family Medicine

Mary S. Boscamp Bozeman Physician Assistant

Mary S. Boscamp Belgrade Physician Assistant

Mary S. Boscamp Livingston Physician Assistant

Alison Braden Carter Billings Certified Registered Nurse Anesthetist

Erica R. Bruen Billings Internal Medicine

Kevin J. Bruen Billings Surgery

Debra L. Burleigh-Gilbert Butte Nurse Practitioner

Amna B. Buttar Butte Internal Medicine

Amna B. Buttar Missoula Internal Medicine

Mary E. Camden Hamilton Obstetrics and Gynecology

Mary Ann Carlson Columbia Falls Pediatrics

Libby J. Catron-Gingerelli Missoula Licensed Clinical Professional Counselor

Brittany J. Coburn Columbia Falls Nurse Practitioner

Mark R. Comaratta Bozeman Ophthalmology

Kim T. Conlin Kalispell Physician Assistant

Jessica D. Cozzens Billings Family Medicine

Laura J. Csaplar Kalispell Internal Medicine

Rebecca L. Danforth Missoula Internal Medicine

Howard A. Davis Helena Licensed Clinical Social Worker

Participating Providers


Donald A. Decker Whitefish Anesthesiology

Frederick A. Deigert Great Falls Radiation Oncology

Charles L. Dixon Kalispell Family Medicine

Stephanie W. Doster Billings Occupational Therapy

Cara S. Douglass Great Falls Internal Medicine

Samuel J. Douglass Great Falls Emergency Medicine

Erika L. Duffy Billings Nurse Practitioner

Erika L. Duffy Lewistown Nurse Practitioner

Kristy J. Ehrmantraut Whitefish Physician Assistant

Tara E. Eller Butte Dentist

Tonja M. Erickson Hamilton Licensed Clinical Professional Counselor

Erin N. Estep Butte Dentist

Kelly A. Ewalt Columbia Falls Licensed Clinical Professional Counselor

Rachel M. Fanska Bozeman Dentist

Rachel M. Fanska Livingston Dentist

Jeffrey E. Feenstra Bozeman Chiropractic

Aaron A. Feist Missoula Emergency Medicine

Shannon K. Foster Missoula Dermatology

Claire A. Francoeur Missoula Nurse Practitioner

Peter H. Frech Bozeman Radiology

Jamee L. Free Billings Licensed Clinical Professional Counselor

Ira E. Gaddy Kalispell Psychiatry

Stephanie A. Gaertig Missoula Physical Therapy

Robert B. Geller Billings Hematology and Oncology

Paolo F. Gerbasi Billings Family Medicine

Christopher H. Gill Kalispell Internal Medicine

Peter J. Gioia Billings Psychiatry

Rachel T. Gooen Missoula Licensed Clinical Social Worker

Barton L. Grant Billings Chiropractic

Jennifer R. Griffis Anaconda Licensed Clinical Social Worker

David Grodsky Bozeman Psychiatry

Heidi L. Grondahl Sidney Nurse Practitioner

Scott M. Guess Missoula Ophthalmology

David C. Habel Kalispell Internal Medicine

Ron L. Hamm White Sulphur Springs Physician Assistant

Courtney T. Hanson Helena Physical Therapy

Nicole A. Henriksen Helena Optometry

Thomas J. Heriza Bozeman Psychiatry

James Peter Heyboer Kalispell Internal Medicine

Amanda E. Hill Butte Pediatrics

Julia M. Horton Missoula Speech Therapy

Bradley Jay Ihrig Missoula Family Medicine

Justin A. Jacobson Missoula Orthopaedics



Adam G. Jensen Missoula Dentist

David Jinich Missoula Cardiovascular Disease

Christopher R. Johnson Great Falls Anesthesiology

Derrick L. Johnson Butte Family Medicine

Michael D. Jones Hamilton Emergency Medicine

Spencer B. Jones Billings Chiropractic

Terry D. Jones Roundup General Practice

Charlotte K. Jutila Belgrade Urgent Care

Melanie A. Klawiter Great Falls Neurology

Peter R. Kollros Missoula Neurology w Special Qualifications in Child Neurology

Margaret C. Kosnar Billings Family Medicine

Jennifer M. Kuklenski Missoula Physical Therapy

Larry J. Lawler Eureka Licensed Clinical Professional Counselor

Sydney R. Lillard Kalispell Surgery

Gretchen K. Lindner Bozeman Psychology

Christopher B. Lindsay Helena Radiology

Robert B. Lininger Bozeman Physician Assistant

Tracy J. Lords Shelby Anesthesiology

Jason Brooks Lunden Bozeman Physical Therapy

Jason Brooks Lunden Manhattan Physical Therapy

Paul E. MacMillan Choteau Physician Assistant

Douglas S. Marbarger Missoula Physician Assistant

Steffan J. May Bozeman Internal Medicine

Jennifer B. Mayo Missoula Obstetrics and Gynecology

Lindsay R. McCarthy Helena Nurse Practitioner

John R. Means Whitefish Surgery

John R. Means Kalispell Surgery

Joan M. Miller Columbia Falls Family Medicine

Patricia A. Moran Ennis Family Medicine

Morledge Family Surg Billings Surgery Center

Cindy L. Murray Scobey Physician Assistant

Douglas A. Nelson Kalispell Internal Medicine

Christopher J. Nero Billings Pathology

Joshua A. Newsted Great Falls Anesthesiology

David L. Nichols Whitefish Anesthesiology

Randy C. Orley Lewistown Chiropractic

Blake M. Passmore Kalispell Licensed Clinical Professional Counselor

Richard M. Penney Dillon Radiology

Karen N. Perser Kalispell Orthopaedics

Kathryn L. Ponto Missoula Obstetrics and Gynecology

Richard E. Popwell Bozeman Neurology

Milissa A. Priebe Great Falls Nurse Practitioner

Gregory H. Pritham Bozeman Urology




Ashley A. Quanbeck Hardin Family Medicine

James G. Randall Billings Ophthalmology

Allen G. Rebchook Havre Surgery

Kacie T. Robertus Billings Nurse Practitioner

Anthony W. Roccisano Billings Orthopaedics

Deborah L. Rohm Bozeman Licensed Clinical Professional Counselor

Lisa R. Ross Billings Obstetrics and Gynecology

Carl J. Roth Great Falls Optometry

Charles S. Rothberg Great Falls Surgery, Neurological

Eric M. Schallock Billings Physician Assistant

Leah F. Schindler Hamilton Nurse Practitioner

Amy M. Sellman Missoula Physical Therapy

Michael H. Spinelli Bozeman Internal Medicine

Jasna Stafford Whitefish Speech Therapy

Carmen K. Staigmiller Great Falls Nurse Practitioner

Robert J. Stenger Missoula Family Medicine

Monte C. Stevens Plentywood Dentist

Sweet Mem Nursing Home Chinook Skilled Nursing / Extended Care

Alicia M. Teausant Great Falls Podiatry

Nancy K. Thorson Billings Licensed Clinical Social Worker

Craig L. Treptow Great Falls Family Medicine

Loren S. Vranish Kalispell Family Medicine

Douglas A. Waldo Great Falls Cardiovascular Disease

Roger L. Wallace Billings Obstetrics and Gynecology

Shon A. Weaver Great Falls Optometry

April L. Weinberger Corvallis Family Medicine

April L. Weinberger Hamilton Family Medicine

Victor K. Weng Great Falls Internal Medicine

Christopher G. Wicher Missoula Urology

Tiffany L. Willis Great Falls Family Medicine

Damian R. Ymzon Havre Surgery

Allison A. Young Missoula Pediatrics

Andrew L. Zimet Whitefish Anesthesiology

The following providers are no longer participating with the Blue Cross and Blue Shield of Montana Traditional Network.

Clinton R. Adkins Hamilton Emergency Medicine

Air Flow Company Plentywood Oxygen Supplier

Kristin E. Airhart Missoula Licensed Clinical Social Worker

Patricia J. Akovenko Whitefish Physical Therapy

Aimee M. Alvord-Brown Billings Physician Assistant

David E. Anderson Helena Certified Registered Nurse Anesthetist



Janeil E. Anderson Billings Licensed Clinical Professional Counselor

Shane K. Anderson Ennis Internal Medicine

Shahriar Anoushfar Havre Surgery

Jennifer L. Armitage Bozeman Physical Therapy

Tricia L. Ayers Lewistown Licensed Clinical Professional Counselor

Francesca F. Aytes Missoula Licensed Clinical Social Worker

Brock M. Barnick Missoula Chiropractic

Dawn M. Birk Miles City Psychology

Dawn M. Birk Colstrip Psychology

Dawn M. Birk Billings Psychology

Richard Boehmler Missoula Speech Therapy

Susan M. Brakefield Kalispell Physical Therapy

Laura M. Braun Bozeman Physical Therapy

Michael Brisbin Billings Certified Registered Nurse Anesthetist

Shirley A. Butler Hamilton Licensed Clinical Social Worker

Shirley A. Butler Stevensville Licensed Clinical Social Worker

Mary Ann Carlson Columbia Falls Pediatrics

Leslie C. Carson Bozeman Licensed Clinical Professional Counselor

Ada H. Casazza Whitefish Licensed Clinical Social Worker

Alison B. Charman Whitefish Nurse Practitioner

Alison B. Charman Kalispell Nurse Practitioner

Savita K. Chaudhry Kalispell Anesthesiology

Denise M. Chumrau Missoula Physical Therapy

Mary A. Clausen Great Falls Physical Therapy

Melinda M. Connelly Bozeman Occupational Therapy

John H. Cook Billings Surgery

Rory J. Cordial Missoula Physical Therapy

Rory J. Cordial Seeley Lake Physical Therapy

Laura J. Csaplar Kalispell Internal Medicine

Brooke N. Curry Billings Physician Assistant

Tanya R. Curtis Sheridan Speech Therapy

Joseph P. Darrah Townsend Occupational Therapy

Denise L Davies Kalispell Occupational Therapy

Denise L Davies Somers Occupational Therapy

Nicole C. DeArmond Kalispell Physician Assistant

Douglas R. Debenham Billings Radiation Oncology

Donald A. Decker Kalispell Anesthesiology

Donald A. Decker Whitefish Anesthesiology

Els DeJong Libby Physical Therapy

Els DeJong Missoula Physical Therapy


Carol L. Dougherty Glendive Speech Therapy

Carol L. Dougherty Miles City Speech Therapy



Debra J. Dunn Billings Licensed Clinical Social Worker

Alfred G. Edwards Great Falls Physical Therapy

Sherry R Ellis Missoula Licensed Clinical Professional Counselor

David J Ericson Bozeman Physician Assistant

Edward K. Esquibel Butte Licensed Clinical Social Worker

Lisa A. Flaming Billings Physical Therapy

Amy M. Foss Whitefish Chiropractic

John Foster Lewistown Licensed Clinical Professional Counselor

Lois A. Freisleben-Cook Billings Pediatrics

Becky J. Frost Missoula Licensed Clinical Professional Counselor


William F. Gertson Great Falls General Practice


Jamie B. Glenn Butte Certified Nurse Midwife

Neil A. Goldenberg Billings Pediatrics

Suzanne E. Goold Missoula Licensed Clinical Social Worker

William J. Graber Missoula Urology

Lonnie L. Gribnau Stevensville Licensed Clinical Professional Counselor


Sara M. Hagedorn Bozeman Physical Therapy

Roy R. Hall Havre Internal Medicine

Earl R Harrison Havre Radiology

Bruce A. Hietala Missoula Licensed Clinical Social Worker

Bruce A. Hietala Butte Licensed Clinical Social Worker

Shelly R. Hocking Kalispell Licensed Clinical Social Worker

Paul W. Holley Billings Pathology

Frances E. Honsharuk Butte Licensed Clinical Social Worker

Horizon Pharmacies Butte Medical Equipment

Clint O. Hoxie Hamilton Optometry

Ronald K. Hull Helena Anesthesiology

Willard J. Hull Billings Orthopaedics

William M. Iannacone Lewistown Orthopaedics

Ron L Isacco Butte Occupational Therapy

Ron L Isacco Deer Lodge Occupational Therapy

Marilyn J. Ivers Great Falls Licensed Clinical Professional Counselor

Jodi L Jeakins-Kok Missoula Nurse Practitioner

Rashel Jeffrey Missoula Licensed Clinical Social Worker

Cindy L. Jensen Libby Licensed Clinical Social Worker

Martha J. Jimenez Hamilton Nurse Practitioner

David F. Johnson Billings Internal Medicine

Michael G. Johnson Missoula Chiropractic

Michael G. Johnson Stevensville Chiropractic



Michael G. Johnson Hamilton Chiropractic

Rose M. Johnson Hamilton Speech Therapy

William A. Jones Billings Physical Therapy

Joseph J. Joslyn Great Falls Physician Assistant

David M. Junker Missoula Anesthesiology

Arlene Karst Fairview Licensed Clinical Professional Counselor

James N. Kelley Havre Family Medicine

Tim J. Khaliqi Great Falls Anesthesiology

Jo Kimery Missoula Licensed Clinical Professional Counselor

Dennis L. Klemp Missoula Certified Registered Nurse Anesthetist

Karen M. LaDuke Bozeman Speech Therapy

Jeremiah E. Larsen Laurel Chiropractic

Juan C. Lastra Cut Bank Psychology

Juan C. Lastra Anaconda Psychology

Cheryl A. Leicht Billings Licensed Clinical Professional Counselor

Cheryl A. Leicht Huntley Licensed Clinical Professional Counselor

Mary L. Louder Billings Family Medicine

Mary L. Louder Big Timber Family Medicine

Mary L. Louder Livingston Family Medicine

James M. Love Miles City Speech Therapy

Janet Maddock Whitefish Speech Therapy

Robert P. Maggard Billings Dentist

Jules W. Marsh Kalispell Family Medicine

Mark S. Mattocks Great Falls Dentist

Kathleen M. Mauer Hamilton Nurse Practitioner

Kathleen M. Mauer Corvallis Nurse Practitioner

Kathleen M. Mauer Whitefish Nurse Practitioner

Timothy J. McCue Missoula Family Medicine

Timothy J. McCue Stevensville Family Medicine

Allison McIntosh Three Forks Clinical Nurse Specialist

Rosemary E. McKinnon Kalispell Licensed Clinical Social Worker

Kay K. McLain Butte Licensed Clinical Professional Counselor

Robert A. McNutt Helena Rheumatology

Gerald E. Miller Hamilton Licensed Clinical Professional Counselor


Thomas J. Miller Billings Ophthalmology

Samuel J. Mitchell Missoula Family Medicine

Kathryn V. Monce Glendive Family Medicine

Christia A. Monroe Big Sky Physical Therapy

Montana Adaptive Equipment Helena Medical Equipment

Howard Steven Moore Belgrade Licensed Clinical Professional Counselor

Howard Steven Moore Bozeman Licensed Clinical Professional Counselor


Jean L. Moylan Bozeman Licensed Clinical Professional Counselor


Gloria I. Nelson Whitefish Occupational Therapy

David L. Nichols Whitefish Anesthesiology

William C. Nicol Miles City Certified Registered Nurse Anesthetist

Darren B. Obrey Bozeman Chiropractic

June O'Connor Butte Licensed Clinical Professional Counselor

Robert E. Okasinski Anaconda Emergency Medicine

Michael B. O'Neill Dillon Psychiatry

Kristen L. Park Billings Neurology w Special Qualifications in Child Neurology

Lance K. Parks Billings Anesthesiology

Jody R. Parrott Butte Licensed Clinical Social Worker

Ann M. Payne Sheridan Physical Therapy

Dale M. Peterson Billings Neurology

Gary R. Peterson Missoula Dentist

Robert D. Pfeffer Helena Radiation Oncology

Heather M. Pfeiffer Kalispell Nurse Practitioner

Heather M. Pfeiffer Columbia Falls Nurse Practitioner

John K. Pike Havre Orthopaedics

Andrew L. Pocock Plentywood Dentist

Grant D. Poor Fairfield Physical Therapy

Jonathan C. Poplin Libby Licensed Clinical Social Worker

Margaret Joan Porter Butte Licensed Clinical Social Worker

Carrie A. Powell Great Falls Nurse Practitioner

Kristene A. Provo Frenchtown Physician Assistant

Kristene A. Provo Missoula Physician Assistant

Kristene A. Provo Lolo Physician Assistant

Esther E. Racz Great Falls Physical Therapy

Roger S. Racz Great Falls Podiatry

Cynthia S. Radue Miles City Occupational Therapy

James G. Randall Missoula Ophthalmology

James G. Randall Hamilton Ophthalmology

Connie S. Reichelt Havre Nurse Practitioner

Connie S. Reichelt Big Sandy Nurse Practitioner

Connie S. Reichelt Great Falls Nurse Practitioner

Ro Montana Great Falls Medical Equipment

Donald Roberts Billings Oral & Maxillofacial Surgery

Jimmy D Robertson Great Falls Optometry

Jason W Rockwood Kalispell Podiatry

Rocky Mountain Medical Billings Medical Equipment

Joel C. Rutherford Billings Podiatry

Jeffry L. Saad Big Sky Chiropractic



Ruth L. Sampson Billings Endocrinology, Diabetes, & Metabolism

John J. Sando Butte Chiropractic

James J. Schellenger Roundup Family Medicine

Ronald R. Schnier Havre Surgery

Ronald R. Schnier Whitefish Surgery

Linda K. Schooley Bozeman Physical Therapy

Lawrence E. Scott Ronan Surgery

Marc M Sewell Billings Licensed Clinical Professional Counselor

David E Siewert Manhattan Internal Medicine

Vincent P Siragusa Butte Cardiovascular Disease

Kevin R. Skocilich Butte Licensed Clinical Social Worker

Karen S. Sloan Lewistown Nurse Practitioner

Tamera J. Smith Bozeman Physical Therapy

Snyders Drug Billings Medical Equipment

Snyders Drug Helena Medical Equipment

Snyders Drug Laurel Medical Equipment

Peter M. Sorini Kalispell Surgery, Neurological

Peter M. Sorini Butte Surgery, Neurological

Gary L. Steinbach Belgrade Physical Therapy

Erin E. Stevens Miles City Obstetrics and Gynecology

Roger E. Terry Butte Physical Therapy

Jazper E. Torres Columbia Falls Chiropractic

Jazper E. Torres Kalispell Chiropractic


Stacy L. Upton Whitefish Physical Therapy

Desiree A. Van Blaricom Deer Lodge Physical Therapy

Desiree A. Van Blaricom Butte Physical Therapy

Desiree A. Van Blaricom Missoula Physical Therapy

Kristin R. Veneman Whitefish Pediatrics


Holly J. Wagley Bozeman Speech Therapy

Sarah C. Walker Kalispell Physician Assistant

Tessa T. Wallace Victor Licensed Clinical Social Worker

Colleen M. Wall-Hoeben Hamilton Psychology

Stewart R. Ward Missoula Optometry

Douglas W. Webber Missoula Emergency Medicine

Mary C. Weber Superior Nurse Practitioner

Mary C. Weber Missoula Nurse Practitioner

Becky J. Wells Ennis Physician Assistant

Mimi Welsh Butte Nurse Practitioner

Marshall W. White Hamilton Obstetrics and Gynecology

Raymond W. White Lewistown Dentist




Sharon Wosnick Billings Licensed Clinical Professional Counselor

Pamela Wright Kalispell Certified Nurse Midwife

Pamela Wright Columbia Falls Certified Nurse Midwife

Sally George Wright Poplar Psychology

L Wayne Yankoff Helena Licensed Clinical Professional Counselor

Yellowstone Ultrasound Billings Radiology Center

Andrew L. Zimet Kalispell Anesthesiology


Blue Cross and Blue Shield of Montana welcomes these new managed care providers.


Stephanie W. Doster Billings Occupational Therapy

Cara S. Douglass Great Falls Internal Medicine

Samuel J. Douglass Great Falls Emergency Medicine

Michelle L. Dykman Belgrade Speech Therapy

Chad L. Eastlick Laurel Chiropractic

Steven D. Edwards Missoula Licensed Clinical Social Worker

Heidi S.M. Elwood Superior Licensed Clinical Social Worker

Jan M. Emerson Bozeman Licensed Clinical Professional Counselor

Cathryn D. English-Straub Helena Licensed Clinical Social Worker

Tonja M. Erickson Hamilton Licensed Clinical Professional Counselor

Jeffrey E. Feenstra Bozeman Chiropractic

Richard L. Fields Columbia Falls Nurse Practitioner

Shannon K. Foster Missoula Dermatology

Claire A. Francoeur Missoula Nurse Practitioner

Peter H. Frech Bozeman Radiology

Jamee L. Free Billings Licensed Clinical Professional Counselor


Stephanie A. Gaertig Missoula Physical Therapy

Mitchell E. Gallagher Billings Radiology

Robert B. Geller Billings Hematology and Oncology

Derek Gilbert Miles City Family Medicine


Dirk M. Gillette Kalispell Physician Assistant

Kristina M. Gillispie Helena Licensed Clinical Social Worker

Anne W. Giuliano Billings Radiology

Milton S. Glatterer Kalispell Surgery, Thoracic

Lisa C. Goodrich Bozeman Speech Therapy

Daniel L. Gregerson Kalispell Licensed Clinical Professional Counselor

Jennifer R. Griffis Anaconda Licensed Clinical Social Worker

David Grodsky Bozeman Psychiatry

Scott M. Guess Missoula Ophthalmology




Ron L. Hamm White Sulphur Springs Physician Assistant

Courtney T. Hanson Helena Physical Therapy

John V. Hanson Billings Radiology

Katie M. Harrer Billings Physician Assistant

Laura O. Heck Bozeman Occupational Therapy

Thomas J. Heriza Bozeman Psychiatry

Cory D. Hessel Great Falls Psychology

James Peter Heyboer Kalispell Internal Medicine

Amanda E. Hill Butte Pediatrics

Jennifer L. Hill Billings Licensed Clinical Professional Counselor

Julia M. Horton Missoula Speech Therapy

Kristina M. Howard Missoula Licensed Addiction Counselor

Barbara B. Howe Helena Licensed Clinical Social Worker

Bradley Jay Ihrig Missoula Family Medicine

Sarah E. Jameson Bozeman Licensed Clinical Social Worker

Catherine B. Jenni Missoula Licensed Clinical Professional Counselor

David Jinich Missoula Cardiovascular Disease

Christopher R. Johnson Great Falls Anesthesiology

Derrick L. Johnson Butte Family Medicine

Mark H. Johnson Great Falls Psychology

Rennae I. Johnson Great Falls Psychology

Michael D. Jones Hamilton Emergency Medicine

Spencer B. Jones Billings Chiropractic

Melanie A. Klawiter Great Falls Neurology

Sarah S. Knell Bozeman Licensed Clinical Professional Counselor

David A. Koeplin Bozeman Radiation Oncology

Peter R. Kollros Missoula Neurology w Special Qualifications in Child Neurology

Gloria C. Kornish Seeley Lake Physician Assistant

Margaret C. Kosnar Billings Family Medicine

Thomas J. Krajacich Great Falls Psychology

Susan J. Kronenberger Helena Licensed Clinical Social Worker

Jennifer M. Kuklenski Missoula Physical Therapy

Linda C. Law Kalispell Family Medicine

Larry J. Lawler Eureka Licensed Clinical Professional Counselor

Sarah J. Lawrence Bozeman Licensed Clinical Professional Counselor

Amanda M. Lewis Billings Licensed Clinical Social Worker

Jennifer A. Lewis Belgrade Occupational Therapy

Sydney R. Lillard Kalispell Surgery

Blythe Lindsay Bozeman Physician Assistant

Christopher B. Lindsay Helena Radiology

Robert B. Lininger Bozeman Physician Assistant

Tracy J. Lords Shelby Anesthesiology



Jason Brooks Lunden Bozeman Physical Therapy

Jason Brooks Lunden Manhattan Physical Therapy

Paul E. MacMillan Choteau Physician Assistant

Douglas S. Marbarger Missoula Physician Assistant

Steffan J. May Bozeman Internal Medicine

Jennifer B. Mayo Missoula Obstetrics and Gynecology

Lindsay R. McCarthy Helena Nurse Practitioner

Susan D. McEwen Kalispell Nurse Practitioner

John R. Means Whitefish Surgery

John R. Means Kalispell Surgery


Montana Heart Angio Missoula Vascular Diagnostic Services

Patricia A. Moran Ennis Family Medicine

Morledge Family Surgical Billings Surgery Center

George C. Mulcaire-Jones Butte Family Medicine

Matthew D. Munding Hamilton Urology

Daniel A. Muniak Lewistown Physician Assistant


Christopher J. Nero Billings Pathology

Joshua A. Newsted Great Falls Anesthesiology

Rebecca J. Oss Helena Licensed Clinical Social Worker

Blake M. Passmore Kalispell Licensed Clinical Professional Counselor

Richard M. Penney Dillon Radiology

Karen N. Perser Kalispell Orthopaedics

Dawn M. Peters Kalispell Nurse Practitioner

Kathryn L. Ponto Missoula Obstetrics and Gynecology

Richard E. Popwell Bozeman Neurology

Milissa A. Priebe Great Falls Nurse Practitioner

Gregory H. Pritham Bozeman Urology

Julie M. Pullen Billings Nurse Practitioner

Ashley A. Quanbeck Hardin Family Medicine

James G. Randall Billings Ophthalmology

Lisa Ann Ranes Billings Registered Dietitian/Nutritionist

Allen G. Rebchook Havre Surgery

Kathy J. Reid Missoula Physical Therapy

Kacie T. Robertus Billings Nurse Practitioner

Anthony W. Roccisano Billings Orthopaedics

Lisa R. Ross Billings Obstetrics and Gynecology

Carl J. Roth Great Falls Optometry

Charles S. Rothberg Great Falls Surgery, Neurological

Kathleen A. Ryan Billings Radiology

Shirley K. Schneiter Missoula Registered Dietitian/Nutritionist



Tyler L. Seick Kalispell Physician Assistant

Robert C. Sherrick Kalispell Internal Medicine

Shodair Hospital Helena Residential Treatment Facility

Brock M. Smith Butte Certified Registered Nurse Anesthetist

Cheri L. Sorg-Hackler Bozeman Speech Therapy

Michael H. Spinelli Bozeman Internal Medicine

Jasna Stafford Whitefish Speech Therapy

Carmen K. Staigmiller Great Falls Nurse Practitioner

Robert L.G. Stears Billings Radiology

Robert J. Stenger Missoula Family Medicine

Jessica M. Stone Bozeman Psychiatry

Colleen K. Stuckey Billings Physician Assistant

Elizabeth M. Sullivan Bozeman Speech Therapy

Jana J. Sund Kalispell Certified Nurse Midwife

Alicia M. Teausant Great Falls Podiatry

Jordan B. Teller Billings Nurse Practitioner


Lindsay M. Tripp Missoula Physical Therapy

Edward H. Trontel Kalispell Psychology


Douglas A. Waldo Great Falls Cardiovascular Disease

Larry Dean Walker Bozeman Physician Assistant

Roger L. Wallace Billings Obstetrics and Gynecology

Mary L. Watson Butte Licensed Clinical Professional Counselor

April L. Weinberger Hamilton Family Medicine

April L. Weinberger Corvallis Family Medicine

Victor K. Weng Great Falls Internal Medicine

Christopher G. Wicher Missoula Urology

Tiffany L. Willis Great Falls Family Medicine

Jeannine R. Willison Cut Bank Licensed Clinical Professional Counselor

Linda L. Winfield Helena Nurse Practitioner

Damian R. Ymzon Havre Surgery

Stacy G. York Billings Licensed Clinical Social Worker

Allison A. Young Missoula Pediatrics


The following providers are no longer participating with the managed care provider network.

Clinton R. Adkins, DO Hamilton Emergency Medicine

Patricia J. Akovenko, PT Whitefish Physical Therapy

David E. Anderson, CRNA Helena Certified Registered Nurse Anesthetist

Barb H. Bailey, PA-C Helena Physician Assistant

George T. Bandow, MD Missoula Cardiovascular Disease

Linda Barone, LCPC Lakeside Licensed Clinical Professional Counselor



Kay Bills-Kazimi, PA-C Helena Physician Assistant

Elisabeth M. Bishop, MD Billings Internal Medicine

John M. Brandon, LCPC Lakeside Licensed Clinical Professional Counselor

Michael W. Brennan, MD Billings Cardiovascular Disease

Andrea J. Breuer, PT Whitefish Physical Therapy

Jonalyn Brown, SLP Billings Speech Therapy

Leslie C. Carson, LCPC Bozeman Licensed Clinical Professional Counselor

Andrew J. Carter, DO Helena Cardiovascular Disease

David P. Chamberlain, MD Butte Internal Medicine

Steven Wayne Chamberlin, MD Helena Anesthesiology

Ammie M. Chapman, DC Billings Chiropractic

Terri L. Christy, LCSW Kalispell Licensed Clinical Social Worker

John H. Cook, MD Billings Surgery

James M. Cooper, MD Cut Bank Obstetrics and Gynecology

Brooke N. Curry, PA-C Billings Physician Assistant

Douglas R. Debenham, MD Billings Radiation Oncology

Lindsey N. Diemert, RD Billings Registered Dietitian/Nutritionist

Paul S. Donaldson, MD Helena Family Medicine

Deborah D. Dover, MD Great Falls Neurology

Margaret A. Ellis, FNP Frenchtown Nurse Practitioner

Edith H. Ellsworth, CNS Great Falls Clinical Nurse Specialist

Susan C. English, MD Billings Internal Medicine

Edward K. Esquibel, LCSW Butte Licensed Clinical Social Worker

Kelly R. Etzel, PA-C Superior Physician Assistant

Kristi J. Fischer, PT Billings Physical Therapy

Joseph T. Flynn, MD Great Falls Pediatric Nephrology

Laura Ford-Mukkamala, DO Billings Internal Medicine

Patricia L. Francisco, PA-C Billings Physician Assistant

Becky J. Frost, LCPC Missoula Licensed Clinical Professional Counselor

Dell A. Fuller, MD Bozeman Family Medicine

Devry Garity, PNP Florence Nurse Practitioner

Kristina M. Gillispie, LCSW Helena Licensed Clinical Social Worker

Sonya M. Gilson, FNP Great Falls Nurse Practitioner

Michael J. Glanzer, OD Great Falls Optometry

Jamie B. Glenn, CNM Butte Certified Nurse Midwife

James S. Good, MD Billings Ophthalmology

Eric L. Greenberg, LCPC Kalispell Licensed Clinical Professional Counselor

Eric L. Greenberg, LCPC Lakeside Licensed Clinical Professional Counselor

Kandis L. Grose, RD Billings Registered Dietitian/Nutritionist

Caryn C. Guse, SLP Missoula Speech Therapy

Beth T. Hall, RD Billings Registered Dietitian/Nutritionist

Earl R. Harrison, MD Havre Radiology



Shelly R. Hocking, LCSW Kalispell Licensed Clinical Social Worker

William L. Hull, DO Missoula Cardiovascular Disease

Kristi A. Hyatt, LCPC Livingston Licensed Clinical Professional Counselor

Mark S. Ibsen, MD Helena Urgent Care

Marilyn J. Ivers, LCPC Great Falls Licensed Clinical Professional Counselor

Martha J. Jimenez, APRN Hamilton Nurse Practitioner

Mark H. Johnson, PHD Great Falls Psychology

Michael G. Johnson, DC Missoula Chiropractic

Rennae I. Johnson, PHD Great Falls Psychology

Joseph J. Joslyn, PA Great Falls Physician Assistant

Donald R. Joyner, MD Great Falls Obstetrics and Gynecology

Karel K. Kearl, LCSW Lakeside Licensed Clinical Social Worker

Tim J. Khaliqi, MD Great Falls Anesthesiology

Meagan L. Kimmel, SLP Billings Speech Therapy

Thomas R. Kinney, LCSW Great Falls Licensed Clinical Social Worker

Howard R. Knapp, MD Billings Internal Medicine

Thomas J. Krajacich, PHD Great Falls Psychology

Paul J. LaVeau, MD Billings Cardiovascular Disease

Benny L. Lindeman, PA-C Ennis Physician Assistant

Diana M. Mann, LCSW Butte Licensed Clinical Social Worker

Jules W. Marsh, MD Kalispell Family Medicine

Shari K. Marx, MD Helena Internal Medicine

Jacob Mathis, MD Billings Surgery, Neurological

Brett B. Maxfield, CRNA Great Falls Certified Registered Nurse Anesthetist

Georgianna S. Mayer, FNP Missoula Nurse Practitioner

Georgianna S. Mayer, FNP Frenchtown Nurse Practitioner

Tracy K. Mayer, LCSW Kalispell Licensed Clinical Social Worker

Janel D. McCormick, PA-C Arlee Physician Assistant

Janel D. McCormick, PA-C Lolo Physician Assistant

Janel D. McCormick, PA-C Frenchtown Physician Assistant

Kay K. McLain, LCPC Butte Licensed Clinical Professional Counselor

Matthew D. McLaren, MD Helena Anesthesiology

Robert A. McNutt, MD Helena Rheumatology

Ralph Adron Medley, MD Helena Surgery

Jeanne L. Mehrens, PA-C Butte Physician Assistant

Gerald E. Miller, LCPC Hamilton Licensed Clinical Professional Counselor

Leslie Chris Munro, NP Butte Nurse Practitioner

Gloria I. Nelson, OT Whitefish Occupational Therapy

Jillian R. Nelson, OT Whitefish Occupational Therapy

Laurie K. Neubauer, PA-C Billings Physician Assistant

David G. Nigh, MD Billings Emergency Medicine

June O'Connor, LCPC Butte Licensed Clinical Professional Counselor


Robert E. Okasinski, MD Anaconda Emergency Medicine

Michael B. O'Neill, MD Dillon Psychiatry

Grant D. Poor, PT Fairfield Physical Therapy

Carrie A. Powell, NP Great Falls Nurse Practitioner

C. Kelley Price, PA-C Choteau Physician Assistant

Kristene A. Provo, PA-C Missoula Physician Assistant

Kristene A. Provo, PA-C Lolo Physician Assistant

Jean-Pierre Pujol, MD Helena Urgent Care

John Pullman, MD Butte Internal Medicine

James G. Randall, MD Hamilton Ophthalmology

Lance S. Reesor, PT Great Falls Physical Therapy

Jason W. Rockwood, DPM Kalispell Podiatry

Daniel V. Rodriguez, MD Billings Neurology

Lisa R. Ross, MD Billings Obstetrics and Gynecology

Sherilyn D. Rossiter, LCPC Missoula Licensed Clinical Professional Counselor

Ruth L. Sampson, MD Billings Endocrinology, Diabetes, & Metabolism

John J. Sando, DC Butte Chiropractic

Lisa S. Schmiesing-Smith, LCSW Helena Licensed Clinical Social Worker

Paul R. Siddoway, MD Butte Internal Medicine

Cindy J. Simpkins, NP Great Falls Nurse Practitioner

Vincent P Siragusa, MD Butte Cardiovascular Disease

Robert M. Skinner, MD Great Falls Ophthalmology

Ronald H. Smith, MD Billings Internal Medicine

Teresa D. Smith, FNP Frenchtown Nurse Practitioner

Teresa D. Smith, FNP Lolo Nurse Practitioner

Jeffrey A. Stephenson, MD Great Falls Radiation Oncology

Marian E. Stuart, LCSW Kalispell Licensed Clinical Social Worker

Thomas H. Swanson, MD Great Falls Neurology

Thomas H. Swanson, MD Bozeman Neurology

John E. Taylor, OD Conrad Optometry

Stacy L. Upton, PT Whitefish Physical Therapy

Colleen M. Wall-Hoeben, PSYD Hamilton Psychology

Ronda L. Wangerin, PT Butte Physical Therapy

Ronda L. Wangerin, PT Deer Lodge Physical Therapy

Mark D. Weber, MD Missoula Physical Medicine & Rehabilitation

Charles Edward Wettach, DC Kalispell Chiropractic

Edward R. White, MD Ronan Orthopaedics

Richard W. Willey, CRNA Great Falls Certified Registered Nurse Anesthetist

Erin L. Williams-Leber, PA-C Butte Physician Assistant

Cynthia Winters, LCPC Lakeside Licensed Clinical Professional Counselor

L. Wayne Yankoff, LCPC Helena Licensed Clinical Professional Counselor

Grace L. Zacaroli, LCPC Billings Licensed Clinical Professional Counselor


Documents

ICD-10 … ARE YOU READY?Education to download full color materials. The toolkit includes guidelines that provide you with key assessment and diagnosis information and color-coded