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Managed Care Organizations (MCO) in Montana

In Montana, a managed care system is a program organized to serve the medical needs of injured workers in an efficient and cost-effective manner by managing the delivery of medical services for a defined population of injured workers, through appropriate health care professionals.  Montana law specifies that Managed Care Organizations practicing within the state of Montana must be certified through the state.  Injured Workers enrolled with an MCO can choose their initial treating physician as long as that treating physician agrees to the rules, terms, and conditions regarding services performed by the MCO.

Montana Codes & Administrative Rules

In an effort to save employers money on worker’s compensation premiums and to increase wage loss benefits to employees, the 2011 Montana legislature made sweeping changes to its Worker’s Compensation system.

Montana Utilization &
Treatment Guidelines

Effective July 1, 2011, Montana adopted utilization and treatment guidelines for workers compensation claims with dates of injury on or after July 1, 2007.  Montana law states that as long as providers treat within the guidelines, no authorization is required unless the guidelines specify that authorization is required.   For those services that require authorization, Majoris® uses its own set of treatment guidelines and a pre-certification/ pre-authorization process.

Montana Medical Status Form

The treating physician or designated treating physician caring for a workers’ compensation patient is required to completely fill out a Medical Status Form each time the injured worker is seen.

HIPAA Information Related to Workers’ Compensation

For information on how HIPAA relates to workers’ compensation see the HIPAA Bulletin click here.

Fee Schedules

In 2007, the Montana Legislature passed legislation that directed the Department of Labor and Industry to establish a RBRVS-based fee schedule for non-facility medical services provided to injured workers.

The Montana Facility Fee Schedule applies to Montana facilities, namely Acute Care Hospitals (ACHs) and Ambulatory Surgery Centers (ASCs), for WC services provided on or after December 1, 2008.