Credentialing in Montana

Montana Healthcare Programs (Montana Medicaid + Healthy Montana Kids), administered by the Department of Public Health and Human Services (DPHHS). Provider enrollment runs through the Provider Services Portal at medicaidprovider.mt.gov. Providers who order, refer, or prescribe for Montana Medicaid members must also be enrolled (42 CFR 455.410).

Montana DPHHS provider portal · checked Jul 2026

Montana Medicaid enrollment can be made effective up to ONE YEAR before the date the completed application is received (or the date all required licenses became effective, whichever is later). Unusually generous, and it means providers can often bill for care delivered while their application was pending.

Mont. Admin. R. 37.85.402 · checked Jul 2026

Montana contracts with NO comprehensive Medicaid managed-care organizations. One of only 10 such states. Montana Medicaid pays fee-for-service through DPHHS, so there are no MCO panels to join: enrolling with the state IS the Medicaid enrollment.

KFF, 10 Things to Know About Medicaid Managed Care · checked Jul 2026

None. Montana law sets no deadline for a health insurer to complete credentialing. Mont. Code Ann. § 33-36-203 requires carriers to adopt provider-selection standards but imposes no timeline, and ARM 6.6.8816 requires credentials review before contracting plus reverification at least every 3 years, also with no decision deadline. Unlike some states, no Montana statute forces an insurer to act within a set number of days.

Montana Code Annotated (mca.legmt.gov) · checked Jul 2026

Montana Part A/B claims are processed by Noridian Healthcare Solutions under MAC Jurisdiction F (JF), which covers Alaska, Arizona, Idaho, Montana, North Dakota, Oregon, South Dakota, Utah, Washington and Wyoming. Medicare enrollment (CMS-855) for Montana providers is filed with Noridian.

CMS. Who are the MACs (Jurisdiction F) · checked Jul 2026

None. No Montana statute or rule requires insurers to use CAQH or any standardized payer-credentialing application, each carrier chooses its own process. (The FSMB Uniform Application accepted by the Board of Medical Examiners is for licensure, not payer credentialing.)

Montana Code Annotated Title 33 (verified negative) · checked Jul 2026

The Montana Board of Medical Examiners (Department of Labor & Industry) is the primary source for license verification, via the free public Licensee Lookup at ebiz.mt.gov/pol.

Montana Board of Medical Examiners FAQ · checked Jul 2026

Montana law prohibits PBMs, third-party payers and discount-card processors from charging pharmacies any credentialing or recredentialing fee (temporary provision effective through June 30, 2029).

Montana Code Annotated (mca.legmt.gov) · checked Jul 2026