online service improvements inside this issue...online service improvements health care services...

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Online Service Improvements Health Care Services (HCS) provider representatives have been traveling the state hosting roundtable work sessions this summer. In these sessions, provider offices learn about online services and work on claim-specific issues with Blue Cross and Blue Shield of Montana (BCBSMT) BlueCard, eBusiness, and Customer Service Representatives.

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aNd Blue shield assoCiatioN. ®registered Marks of the Blue Cross aNd Blue shield assoCiatioN, aN assoCiatioN of the iNdepeNdeNt Blue Cross aNd Blue shield plaNs.

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A NEWSLETTER FOR MONTANA HEALTH CARE PROVIDERS

Inside This IssueFrom the Network Administrator ........................... 3Medical Policy ......................................................... 4Regular Business .................................................... 5BlueCard®• BlueCardProgramProviderSatisfactionSurvey• PPLMontanaCoverageBasedinPennsylvaniaTriCare/TriWest• ProviderSeminarOctober27• ShareYourEmailwithTriWest• TriWestHealthcareAllianceAwardedContractBCBSMT• HealthyMontanaKidsBeginsOctober1• NewMedicareAdvantageEducationRequirements• MedicareBluePPOClinicalPracticeGuidelinesAvailableOnline

• ProviderManualUpdates• NewTelecommunicationsSystem

Fraud ....................................................................... 10• HowBigisHealthCareFraud…Really?

Participating Providers ........................................ 11• ParticipatingProvidersMay1toJuly31,2009

Third Quarter 2009

www.bcbsmt.com

[ Third Quarter 2009 ] CapsuleNews 2

Cover Story

[Continued from page 1]

These meetings have been very productive for everyone attending, and this article explains some of the improvements resulting from these meetings.

Provider EducationHCS has developed a webpage for new providers and their staff that will answer commonly asked questions and link them to other pages and documents on our website. This education page is an easy-to-use starting point for learning how to use the information and features available at www.bcbsmt.com. This page has been the presentation format for this summer’s roundtable meetings.

Provider Online Services Quick Reference GuideBCBSMT has created a Provider Online Services Quick Reference Guide that explains the registration process and shows screen prints of most online services. The guide provides detailed descriptions explaining how to perform certain tasks such as searching for patient information, checking claim status, and verifying benefits, eligibility, and deductibles. It also shows you how to look up payment history, use BlueExchange, and update office staff information.

The Quick Reference Guide is published at www.bcbsmt.com (Click on Providers and then Provider Education).

Online Information Updates If you are registered to view claims, benefits, and eligibility as an Office Administrator, you can now submit changes to your provider’s file directly to HCS database maintenance staff. When you log in, click Info Update on the left menu to open our new Change of Status Form. Once your information is entered, click Submit at the bottom of the screen to send your request directly to HCS. If you do not see Info Update in the left menu, you are registered as an Office Staff User and do not have this feature. See your Office Administrator to have your change submitted online or they may update your access to include this option. An example is included below.

Email Option for Provider Administrators As an Office Staff Administrator, you register employees as Office Staff Users and allow them access to patient information. After you click Submit on the Office Staff Registration page, a screen will display the new user’s User ID and Password. There is now a direct email option on this screen so you can simply email the User ID and Password to your staff. The email address on the confirmation screen does not have to match the email address used for setting up the account.

Blue Exchange is Now Faster, EasierBlue Exchange allows you make inquiries about patient eligibility or claims from another Blue Plan or for Federal Employee Program members. Now you do not have to reenter provider information for each request. The provider’s information is now prepopulated to save you time when submitting a new Claims Request or Eligibility Request. The format of the screen was also changed to read last name, first name, and middle initial, and the response time has improved to about 10 seconds per request.

BCBSMT is excited about these enhancements, and our goal is to make your office more efficient by providing the answers you need and saving you time spent on the phone. If you have suggestions for improvement, email your provider representatives at [email protected]. Log on, register, and start saving time with us today!


BCBSMT Provider Satisfaction Survey

BCBSMT is preparing for its annual provider satisfaction survey, and 1,800 participating professional providers will be randomly selected and mailed a 21-question survey in September and October. The Myers Groups from Snelville, Georgia, administers the three-wave mail survey, and we encourage you to respond as soon as possible. Results from the survey will be published in the first quarter 2010 Capsule News.

The survey results help BCBSMT develop a comprehensive plan for improving and maintaining provider satisfaction. Health Care Service provider representatives then develop workshop agendas, personal visits, and Capsule News articles from the satisfaction values measured and direct comments taken from the survey results.

Overall satisfaction in 2008 was 82.7% compared with 86.9% in 2007. While this represents a 4.2% decrease in overall satisfaction, it does not reflect a diminished commitment to improve our service to the Montana medical community. We are always striving to improve our service and processes so that you can take care of our members’ physical and mental health while we provide for our members’ financial security when faced with serious and chronic illnesses.

BCBSMT survey results are strictly confidential. If you have questions or suggestions for improvement, contact your Provider Network Service Representatives at [email protected] or at 1-800-447-7828, Extension 3600.

Send Comments Or Questions To:

Michael Mcguire, editorBlue Cross and Blue shield of Montanap.o. Box 4309helena, Mt [email protected]

From The Network Administrator

The Capsule News is a quarterly publication

for Montana health care providers.

Any material in the Capsule News may

be reproduced with proper credits.

Paul PedersenNetwork AdministratorHealth Care Services


Medical Policy

Medical 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 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.

Participating 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 July 2009 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.

©2009 Blue Cross and Blue Shield of Montana

Medical Policies Index

New PoliciesAnkle Replacement•Cochlear Implant•Auditory Brain Stem Implant•Computer-Aided Evaluation (CAE) of Malignancy with •Magnetic Resonance Imaging of the BreastComputed Tomography to Detect Coronary Artery •CalcificationPosterior Tibial Nerve Stimulation for Voiding Dysfunction•Femoroacetabular Impingement, Surgical Treatment•Genetic Testing for Helicobacter pylori Treatment•Pelvic Floor Stimulation as a Treatment of Urinary •IncontinencePulmonary Vein Isolation as a Treatment of Atrial •FibrillationMagnetic Resonance Imaging to Monitor Integrity of •Silicone Gel-Filled Breast ImplantsHearing Aids - Implantable Bone-Conduction and Bone-•Anchored Hearing AidsRadiofrequency Facet Joint Denervation•Blepharoplasty (Eyelid Surgery)•Bone Growth Stimulators: Electrical Stimulation of the •Appendicular Skeleton

Bone Growth Stimulators: Electrical Stimulation of the •Spine as an Adjunct to Spinal Fusion ProceduresDurable Medical Equipment - Replacements, Duplicates, •Upgrades, Repair and MaintenanceHome Sleep Studies, Unattended/Unsupervised•Intensity-Modulated Radiation Therapy (IMRT): Abdomen •and PelvisPositron Emission Tomography (PET) Scanning in •Oncology to Monitor Early Treatment ResponseRosacea, Non-Pharmacologic Treatment of•Sacral Nerve Modulation/Stimulation for Pelvic Floor •DysfunctionScintimammography/Breast Specific Gamma Imaging•Surgical Treatment of Gynecomastia•Surgical Treatment of Abdominal Skin Redundancy •following Weight Loss-Panniculectomy/Abdominoplasty Surgical Treatment to Correct Ear Deformity: Prominent •EarsVertebral Fracture Assessment with Densitometry•

Revised PoliciesGefitinib (Iressa)•

Click to go to Medical Policy

http://mt1-bcbs.bcbsmt.com/bsd/MedicalPolicy.nsf/DisclaimerPage?OpenPage


BlueCard® BlueCard Program Provider Satisfaction SurveyThe BCBS Association is conducting their second phase of the BlueCard Program satisfaction survey. The BlueCard survey is conducted twice a year (June/August and October/November.

The Blue Cross and Blue Shield Association’s BlueCard Program is using an independent research company called Synovate to conduct telephone interviews on behalf of BCBSMT using a randomly selected sample of providers who have served BlueCard members within the past year. The Response Center will ask to speak with the person who is most knowledgeable about filing Blue Cross and Blue Shield claims and/or the billing department.

As a reminder, both surveys will not ask for any personal or confidential information such as provider or tax identification or social security numbers. Do not provide anyone with personal or sensitive business information.

If you have questions about these surveys, email Mike McGuire at [email protected].

PPL Montana Coverage Based In PennsylvaniaEffective January 1, 2009, PPL Montana’s insurance coverage is based in Pennsylvania with Highmark Blue Cross and Blue Shield. Providers are reminded to copy your patient’s ID card because the alpha prefix is critical to timely processing of claims through the BlueCard Program.

Member eligibility, benefits, and precertification information is available by calling 1-800-676-2583. All claims and claim inquiries should be directed to BCBSMT. If you are registered with us at www.bcbsmt.com, this information is available through BlueExchange. More BlueCard Program procedures are in the BCBSMT Provider Manual published on our website (click on Providers and then Provider Manuals).

TriCare/TriWest TriCare/TriWest Provider Seminar October 27TriWest Healthcare Alliance is hosting a provider education seminar in Great Falls on October 27, 2009. The seminar runs from 1 to 3:30 p.m. at the Holiday Inn at 400 10th Avenue South in the Aronson Room. You must preregister, and there is no charge to attend the seminar.

Each attendee will receive a new Provider Handbook and Quick Reference Guides. New information about the enhanced functionality of the secure provider portal will be presented along with a review of current TriWest Healthcare policies and procedures.

Register online at triwest.com/provider. You will receive email confirmation, be entered into a drawing for a small door prize, and receive a reminder email about the conference date, time, and location. The seminar should last about 2.5 hours and includes time to ask questions.

If you have questions about the agenda, email [email protected] or call 1-888-TRIWEST (888-874-9378).

Share Your Email with TriWest TriWest Healthcare Alliance is collecting provider email addresses to be able to instantly send messages to your office. TriWest will not sell or distribute your email address to other organizations and will be able to instantly inform you about program changes, policy and procedure updates, educational opportunities, and events in your community.

You can provide your email address to TriWest by simply registering for the TRICARE eNews at www.triwest.com or by calling TriWest at 1-888-TRIWEST (888-874-9378).

Editors Note: You can also share your email with BCBSMT by sending an email to [email protected]. We also do not share your email address and only use it to notify you of the Capsule News availability and to supplement direct mail. If you have questions about email usage, send your concerns to [email protected].

Regular BusinessRegular Business


TriWest Healthcare Alliance Awarded Third TRICARE ContractThe TriWest Healthcare Alliance was awarded its third consecutive contract to serve military families seeking care outside military treatment facilities. The TriWest Healthcare Alliance includes 15 not-for-profit health care organizations and two university hospital systems located throughout the 21-state TRICARE west region. BCBSMT is proud to be part of this alliance serving 2.7 million members of America’s military family.

If you have questions, email Ronda DeMars at [email protected].

BCBSMTHealthy Montana Kids Plan Begins October 1Jackie Forba, HMK Program Manager

On October 1, children’s Medicaid and the Children’s Health Insurance Plan (CHIP) will combine and become the Healthy Montana Kids (HMK) Plan, expanding free or low-cost health coverage for Montana children and teens.

The change comes less than a year after Montana voters approved the Healthy Montana Kids ballot measure, changing income guidelines and extending eligibility to 29,000 more Montana children.

HMK/HMK PlusMontana Medicaid and CHIP children who are eligible for benefits in October will be enrolled in the Healthy Montana Kids Plan. The Healthy Montana Kids Plan offers health care coverage to uninsured Montana children in two coverage groups. Depending on family income, children will either be in the HMK coverage group, which used to be CHIP, or the HMK Plus coverage group, which used to be children’s Medicaid.

Under the new income guidelines, a family of four could earn up to $55,125 a year and their children could qualify for the HMK Plan.

Children enrolled in the HMK coverage group receive an HMK member ID card, have the current CHIP benefit package and their services are reimbursed at the CHIP reimbursement rate. Children enrolled in the HMK Plus coverage group receive an HMK Plus ID card and have the current Medicaid benefit package. Their services are reimbursed at the Medicaid reimbursement rate and children are enrolled in the Passport to Health Program.

Since income guidelines for both coverage groups increase, many children enrolled in the HMK coverage group will transition to the HMK Plus coverage group when they reapply during the next year. There will also be a significant number of children at higher income levels who will qualify for the HMK coverage group.

Here’s a look at a few other notable changes:

There is no asset test for families applying for HMK.•

There is a 12-month continuous eligibility span for •children enrolled in the plan (some exceptions apply).

The time a child must be uninsured prior to enrollment •in the HMK coverage group increases from one month to three months. There are some exceptions. There is no comparable waiting time for children eligible for HMK Plus.

Families applying for HMK must provide proof of •citizenship, proof of identity for teens age 16 and older and documents to verify family income. These guidelines are already part of the application process for HMK Plus coverage.

All children, enrolled in either CHIP or a children’s Medicaid program in October, will receive new HMK or HMK Plus member identification cards.

Regular Business



Provider NewsCurrent providers do not need to apply to be providers for the Healthy Montana Kids Plan. There is an automatic enrollment for Medicaid providers as providers for the HMK Plus coverage group and CHIP providers as providers for the HMK coverage group.

Providers should verify a child’s eligibility at each visit via web portal, fax back, or automated voice response. Both HMK and HMK Plus eligibility may be confirmed at these sites. Contact information for those services – including toll-free phone numbers, e-mail addresses, web addresses and mailing addresses – is on the back of each member’s ID card and available at www.mtmedicaid.org.

Enrollment PartnersThe Healthy Montana Kids Plan is recruiting “HMK Enrollment Partners” to help Montana families apply for children’s health coverage. Enrollment Partners may be an individual or organization that works with children and families, e.g., health care providers, educators, community organizations, and others.

HMK staff will train Enrollment Partners to answer general questions and provide hands-on assistance with the HMK Plan application process. Partners will also review documents to verify citizenship and identity, and may share resources – like computers or fax machines – to help families apply for the Healthy Montana Kids Plan.

More InformationThe following is a link to a Healthy Montana Kids Power Point presentation for health care providers: http://hmk.mt.gov/hmkpresentation_files/frame.htm

If you are not a Medicaid provider and would like to enroll as a Medicaid/HMK Plus provider, please contact Provider Relations at MTPR [email protected] or 1-800-624-3958. If you are not a CHIP provider and want to enroll as a CHIP/HMK coverage group provider, contact Provider Relations at [email protected] or 1-800-447-7828, Extension 3600.

Please contact HMK Community Relations Manager Michael Mahoney at 406-444-7877 or [email protected] if you have questions about the HMK Plan or would like information about becoming an Enrollment Partner.

Healthy Montana KidsIncome Guidelines*

Family Size(including adults)

Family annual income(approximately)

2 $36,425

3 $45,775

4 $55,125

5 $64,475

6 $73,825

7 $83,175

8 $92,525

9 $101,875

10 $111,225

* Guidelines effective October 1, 2009

Families who earn more than the guidelines should still apply because additional income adjustments are made based on the number of family members who are employed and whether they pay for child care or care for a disabled or dependent adult.

Regular Business



Regular Business

New Medicare Advantage Education Requirements

Organizations and individuals that contract with BCBSMT and Medicare Advantage to provide health, prescription, or administrative services must meet new Center for Medicare & Medicaid Services (CMS) education and training requirements related to fraud, waste, and abuse (FWA).

As a Medicare Advantage Organization, BCBSMT is responsible for oversight and monitoring of provider training. Providers are responsible for initiating, documenting, and including the education in annual and new employee training programs. The training must be completed by December 31, 2009, as required by CMS.

About the Training Providers may choose to take the free training directly by logging onto yourmedicaresolutions.com or from another Medicare Advantage organization or Part D sponsor. You only need to complete one compliance FWA training program each year.

The training provides an overview of a compliance program and examples of how you can detect, correct, and prevent FWA. The training contains an attestation form to be completed by a representative of your organization and submitted to us as proof that you completed the training. Upon request, your office may be required to submit copies of training logs demonstrating that employees and contractors complied with the training requirement.

The training extends to those that directly handle Medicare business such as coders, billers, physicians, medical staff, contractors, and directors. If your organization chooses to complete training sponsored by another organization, you must still document compliance by indicating this on the attestation form.

If your organization has contracted with other entities to provide health and/or administrative services to Medicare enrollees, you need to obtain attestations of training from those entities, and if requested, those entities will also need to provide copies of your training logs.

Access the TrainingBCBSMT is offering online training at no cost at yourmedicaresolutions.com. The attestation form and submission instructions can be found at the end of the training and should be submitted by December 31, 2009. Log onto www.yourmedicaresolutions.com and select For Providers, then Provider Guide.

If you have questions, contact provider service at 1-888-457-3009.

Clinical Practice and Disease Management Guidelines Available OnlineIn May 2006, the Regional Quality Improvement Committee approved the implementation of the Institute for Clinical Systems Improvement Clinical Practice Guidelines for the MedicareBlue PPO plan administered by the BCBS Northern Plains Alliance. The guidelines were developed using an evidence-based approach, which emphasizes the critical evaluation of scientific evidence rather than expert opinion or consensus. Currently published guidelines include Adult Breast and Cervical Cancer Preventive Guidelines and Chronic Obstructive Pulmonary Disease (GOLD) Guideline.

In addition, MedicareBlue PPO also offers a heart failure disease management program based on the American College of Cardiology and American Heart Association’s 2005 guideline for the Diagnosis and Management of Chronic Heart Failure in the Adult.

The guidelines and disease management program are published in their entirety online at www.yourmedicaresolutions.com (click For Providers). If you do not have Internet access and require a printed copy, contact Kris Thompson at 406-444-8905.

BCBSMT Provider Manual Updates

The BCBSMT Provider Manual has been updated and published at www.bcbsmt.com (Click on Providers and then Provider Manuals). The manual is continually reviewed for clarity and style with the goal of providing simple and direct instructions. A summary of material changes made for the third quarter of 2009 includes:

1. Updated revenue codes to be billed for outpatient laboratory, x-ray and machine tests. (12-5)

If you have suggestions for improvement or content, email your Provider Network Service Representatives at [email protected] or call 1-800-447-7828, Extension 3600.



Regular Business

New Telecommunications SystemInternal Telephone Extensions to ChangeBCBSMT is upgrading its phone system on September 25. The toll-free numbers for BCBSMT (1-800-447-7828) and the Federal Employee Program (1-800-634-3569) will not change, but internal extensions and the local number will change. Our new Helena number is 437-5000.

Continue to call Customer Service at 1-800-447-7828 for routine business. With this upgrade, the Interactive Voice Response (IVR) selections have been simplified. The voice response option has been removed and the system only uses touch-tone navigation. To speak with customer service, select Option 1 and then select Option 2 to identify yourself as a provider. You will then be prompted to verify your provider information.

Claim status and eligibility information will continue to be available through the IVR. Member benefits are no longer available through the IVR. This information and much more is available 24 hour-a-day, seven days-a-week when you register for provider online services at www.bcbsmt.com.

The Health Care Services (HCS) Provider Service Representatives Extension 3600 will be change to Extension 6100. Call HCS when you have contracting or credentialing issues. You may also send an email to [email protected].

Fax numbers throughout the company will also change:

DEPARTMENT NEW FAX

BlueCard 406-437-7867

Claims 406-437-7885

Credentialing 406-437-7881

Customer Service 406-437-7875

Federal Employee Program 406-437-7886

Health Care Services 406-437-7879

Medical Review 406-437-7863

Integrated Health Management phone and fax numbers will remain the same.

If you have questions, call Customer Service at 1-800-447-7828.



Fraud

How Big is Health Care Fraud … Really? Health Care Fraud Receiving Increased Attention as Part of Health Care ReformMost of us already know how large the American health care system is, and if you didn’t, the media has recently let you know as part of their discussion on health care reform. In 2007 (the most recent year for which full statistics are available), Americans spent $2.24 trillion dollars on health care. The Federal Bureau of Investigation estimates that between 3-10% is lost to health care fraud. In other words, between $67-224 billion was stolen from the American public through health care fraud in a single year. These losses are paid by all Americans, either through increased taxes and premiums, reduced benefits, or loss of insurance.

To put these losses in perspective, $224 billion is equal to or greater than the Gross Domestic Product of 138 countries, including Portugal, Denmark, Ireland, and New Zealand. Worse yet, health care costs are projected to rise rapidly over the next 10 years and the resulting cost of fraud is likely to rise as well. If these figures aren’t enough to convince you that fraud is really a problem, the Coalition Against Insurance Fraud has provided information showing the impact to our country, economy, and health care system.

The Coalition takes a more conservative estimate (about 4%) in calculating the amount of insurance fraud in the health care system. However, this estimate still amounts to approximately $80 billion every year. With $80 billion, you could pay:

The salaries of 2.2 million American workers for one •year

All personal income taxes for 7.4 million Americans for •one year

Every CEO of America’s 500 largest companies for the •next 16 years

You could also:

Pay for nearly half of all prescription drugs purchases •for one year

Fund all U.S. cancer research for the next 13 years•

Build 293,000 new homes•

Buy 3 million new cars •

Launch 62 space shuttle missions•

Staggering, isn’t it? Help us stop fraud. All it takes is a phone call.

_____________________________________________________

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 20 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 8211, or by email at [email protected].

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.

Fraud Alert!We have received reports from providers who have been sent a letter instructing them to pay a few hundred dollars to be listed in a TriCare/TriWest/CHAMPUS provider directory. This is not true, and providers should ignore these solicitations.

The Blue Cross and Blue Shield Association also conducts provider satisfaction telephone surveys for the BlueCard Program in the spring. Callers will ask questions related to your satisfaction with the BlueCard Program and not ask for any confidential information such as tax ID or bank account numbers.

If you have questions, email Health Care Services at [email protected], or call 1-800-447-7828, Extension 3600.


Participating Providers: May 1 to July 31, 2009The 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 in our network management system and are listed below.

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

Rudo Ambayi, MD Havre Internal Medicine

Steven D. Arbogast, DO Billings Neurology

Jeffrey R. Avansino, MD Missoula Surgery

Marci L. Barker, MD Great Falls Family Medicine

Zachary M. Bland, MD Billings Radiology

Chantelle R. Braham, LCSW Livingston Licensed Clinical Social Worker

Gary A. Breetz, MD Billings Emergency Medicine

Karen E. Breetz, MD Billings Pediatrics

Paul J. Byorth, MD Billings Otolaryngology

Carol T. Cady, MD Missoula Allergy & Immunology

Jenifer D. Caldwell, PA Missoula Physician Assistant

Ammie M. Chapman, DC Billings Chiropractic

Susan E. Cheeseman, APRN Kalispell Nurse Practitioner

Denise M. Chumrau, PT Missoula Physical Therapy

Patrick J. Cindrich, MD Missoula Surgery, Neurological

Barry W. Cohan, MD Great Falls Endocrinology, Diabetes, & Metabolism

Jeremy O. Comin, DO Billings Anesthesiology

Gerard P. Connor, MD Billings Obstetrics and Gynecology

Kristopher G. Cunningham, MD Harlowton Family Medicine

Kristopher G. Cunningham, MD Lewistown Family Medicine

Anthony R. Dal Nogare, MD Kalispell Internal Medicine

Kyle L. Dale, MD Missoula Radiology

Mark B. Darcey, CRNA Helena Certified Registered Nurse Anesthetist

Michael C. DiCello, MD Bozeman Allergy & Immunology

Susan C. Dilatush, DC Missoula Chiropractic

George T. Drugas, MD Missoula Pediatric Surgery

Kathleen J. Durant, DC Red Lodge Chiropractic

Lori A. Durocher, NP Great Falls Nurse Practitioner

Jason H. Fleischmann, DMD Helena Oral Surgery

Kelli R. Gibbs, PA Missoula Physician Assistant

Jon R. Gildea, DO Missoula Emergency Medicine

Kenneth W. Gow, MD Missoula Pediatric Surgery

Elizabeth J. Grimley, MD Missoula Urgent Care

Bryan D. Haight, DDS Shelby Dentist

Alicia M. Hamilton, PA Great Falls Physician Assistant

Burke E. Hansen, MD Dillon Family Medicine

James B. Harris, MD Dillon Radiology

Shauna D. Hayes, DMD Livingston Dentist

Mark S. Hegyes, MD Plentywood General Practice

Marisa D. Hess, OD Livingston Optometry

Janie M. Hett, DPT Corvallis Physical Therapy

Christina Yen Fen Ho, MD Billings Family Medicine

Melissa C. Hulvat, MD Kalispell Surgery

James Lawrence Hurm, MD Culbertson Family Medicine

Kelly Jo Hylland, SLP Billings Speech Therapy

Patrick J. Javid, MD Missoula Surgery

Linda K. Johnson, MD Billings Obstetrics and Gynecology

Participating Providers


Paul M. Johnson, MD Great Falls Family Medicine

Thomas F. Kent, MD Billings Gynecology

Katie N. Kopina Buser, CNM Billings Certified Nurse Midwife

Kathryn E. Lederer, FNP Miles City Nurse Practitioner

Alysan N. Long, DPT Bozeman Physical Therapy

Alysan N. Long, DPT Belgrade Physical Therapy

Theodore J. Losey, MD Kalispell Emergency Medicine

Kathryn A. Lysinger, MD Billings Pediatrics

Heather E. Maddox, MD Missoula Family Medicine

Brian J. Malloy, MD Great Falls Urology

Alan L. Mannheimer, MD Billings Pediatrics

Bryan E. Martin, MD Great Falls Internal Medicine

Heidi M. Matlack-Larson, LCSW Butte Licensed Clinical Social Worker

Margarete D. McLaren, CRNA Great Falls Certified Registered Nurse Anesthetist

Douglas G. McLaws, DO Deer Lodge Family Medicine

Michael J. Mitchell, MD Kalispell Anesthesiology

Christopher P. Montville, MD Billings Obstetrics and Gynecology

Allison G. Murphine, PT Billings Physical Therapy

Ronald S. Murray, MD Billings Neurology

Colleen L. Muzynoski, MD Billings Pediatrics

Gregory S. Oblander, DC Billings Chiropractic

Rhiannon J. Ohman, DPT Belgrade Physical Therapy

Julie C. Ponti, PA-C Kalispell Physician Assistant

Robert G. Putzker, DPT Helena Physical Therapy

Esther E. Racz, DPT Great Falls Physical Therapy

Roger S. Racz, DPM Great Falls Podiatry

Douglas S. Reagan, MD Kalispell Orthopaedics

James F. Richards, MD Billings Neurology

Michelle Rosario, MD Billings Obstetrics and Gynecology

Michael D. Ruszkowski, NP Helena Nurse Practitioner

Linda A. Saunders, DO Billings Family Medicine

Margaret R. Schlesinger, MD Missoula Rheumatology

William E. Schoderbek, MD Helena Internal Medicine

Eric B. Schubert, MD Billings Surgery, Neurological

Ralf Schurmann, DC Helena Chiropractic

Ryan P. Schwanke, MD Billings Family Medicine

Travis E. Sherman, DPT Billings Physical Therapy

Catherine C. Silva, APRN Helena Nurse Practitioner

Jerry W. Speer, MD Great Falls Family Medicine

Richard L. Spillman, PA-C Billings Physician Assistant

Shannon M. Steiner, PT Billings Physical Therapy

Jillian S. Stieg, SLP Billings Speech Therapy

Trevor R. Strupp, DMD Livingston Dentist

Colleen K. Stuckey, PA Belgrade Physician Assistant

Janelle J. Sunvold-Palmer, NP Billings Nurse Practitioner

Jill E. Syth, SLP Bozeman Speech Therapy

Charles C. Talton, MD Anaconda Family Medicine

Geoffrey B. Taylor, DO Great Falls Anesthesiology

Timothy W. Thornton, PA Plains Physician Assistant

Kendrick A. Trostel, MD Billings Nephrology

Julie K. Vollertsen, DC Helena Chiropractic

Kim W. Waterfall, MD Hamilton Family Medicine

Galen A. Wilson, LCSW Great Falls Licensed Clinical Social Worker

Valarie K. Zimmer, SLP Billings Speech Therapy



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


Jason G. Bechard, MD Kalispell Internal MedicineKurt P. Benson, PHD Livingston PsychologyKurt P. Benson, PHD Bozeman Psychology

Susan E. Bodurtha, APRN Missoula Clinical Nurse Specialist

Susan E. Bodurtha, APRN Kalispell Clinical Nurse Specialist

Paul J. Byorth, MD Billings Otolaryngology

Paul J. Byorth, MD Colstrip Otolaryngology

Keith L. Cavanaugh, MD Billings Pediatric Pulmonology

Charles S. Charman, MD Whitefish Internal Medicine

Charles S. Charman, MD Kalispell Internal Medicine

Charles S. Charman, MD Columbia Falls Internal Medicine

Theodore J. Chase, PA-C Helena Physician Assistant

Theodore J. Chase, PA-C Miles City Physician Assistant

Richard Ryan Coburn, DMD Great Falls Dentist

Mindy D. Davis, LCSW Billings Licensed Clinical Social Worker

Lisa A. Dighans, NP Poplar Nurse Practitioner

William L. Doyle, MD Missoula Emergency Medicine

Chris R. Duffy, DC Missoula Chiropractic

Erik A. Dufner, MPT Miles City Physical Therapy


Scott W. Falley, MD Helena Internal Medicine

Lisa H. Freeland, CNM Great Falls Certified Nurse Midwife

Herbert I. Fried, MD Billings Surgery, Neurological

Steven W. Galyon, MD Sidney Otolaryngology


Jennifer K. Hall, MD Great Falls Pediatrics

Ronald K. Handlos, PA-C Billings Physician Assistant

Daniel E. Hesskamp, MD Helena Internal Medicine

Elizabeth S. Hill, LCSW Butte Licensed Clinical Social Worker

Elizabeth S. Hill, LCSW Philipsburg Licensed Clinical Social Worker

James C. Hinshaw, MD Billings Obstetrics and Gynecology

Brian R. Hood, PA-C Bozeman Physician Assistant

Katherine P. Humphrey, PT Stevensville Physical Therapy

Katherine P. Humphrey, PT Missoula Physical Therapy

Katherine P. Humphrey, PT Seeley Lake Physical Therapy

Katherine P. Humphrey, PT Missoula Physical Therapy

John A. Huntington, PA Billings Physician Assistant

Donna D. Johnson, LCPC Billings Licensed Clinical Professional Counselor

Paul M. Johnson, MD Sidney Family Medicine


Kurt T. Kubicka, MD Helena Family Medicine

Monica L. Maher, NP Billings Nurse Practitioner


Levi C. Maltby, DMD Conrad Dentist

John M. McCraney, MD Great Falls Anesthesiology

Heidi A. McNulty, DO Missoula Family Medicine

Rebecca A. Metcalf, PT Livingston Physical Therapy

Rebecca A. Metcalf, PT Butte Physical Therapy

Greg J. Moore, MD Missoula Emergency Medicine

Paul R. Morrison, PT Manhattan Physical Therapy

Pierre Y. Musy, MD Bozeman Otolaryngology

Billie L. Nelson, LCPC Kalispell Licensed Clinical Professional Counselor




Sandra L. Nicholson, PA-C Great Falls Physician Assistant


Andrew S. Orton, DDS Livingston Dentist

Steven L. Pailet, DO Bozeman Anesthesiology

Douglas J. Parker, MD Billings Emergency Medicine

Andrew M. Rashkow, MD Great Falls Interventional Cardiology

J. Randall Rauh, MD Miles City Obstetrics and Gynecology

Julie A. Reil, MD Billings Family Medicine

Susan M. Reynolds, APRN Hamilton Nurse Practitioner

Michael J. Rider, DPT Helena Physical Therapy

Eric C. Roberts, MD Great Falls Physical Medicine & Rehabilitation

Sarah Rongstad, SLP Billings Speech Therapy


Amber M. Skorpil, PA-C Plentywood Physician Assistant

Teresa D. Smith, FNP Libby Nurse Practitioner

Teresa D. Smith, FNP Hamilton Nurse Practitioner

Tara Smith-Garcia, NP Kalispell Nurse Practitioner

Stephen F. Speckart, MD Missoula Internal Medicine


Lawrence G. Splitter, DO Billings Preventive Medicine

Michael S. Strekall, MD Helena Family Medicine

Janice M. Thompson, LCSW Billings Licensed Clinical Social Worker

Thomas G. Troop, MD Billings Family Medicine

Timothy W. Urell, DO Great Falls Family Medicine

Cynthia A. Van Beek, SLP Billings Speech Therapy

Douglas D. Van Marel, MD Miles City Internal Medicine

Robert B. Van Nice, MD Laurel Family Medicine

Sarah C. Wagner, PA-C Billings Physician Assistant

Sarah C. Wagner, PA-C Joliet Physician Assistant

Karen L. Watson, LCPC Bozeman Licensed Clinical Professional Counselor

Mark T. Welch, MD Kalispell Internal Medicine

Cheri N. Wells, SLP Bozeman Speech Therapy

William John Wessell, LCPC Billings Licensed Clinical Professional Counselor

Brett M. Williams, FNP White Sulphur Springs Nurse Practitioner

Thomas W. Zavoral, MD Great Falls Emergency Medicine

Blue Cross and Blue Shield of Montana welcomes these new managed care providers. Ashley A. Abbey, LCSW Billings Licensed Clinical Social Worker

Rudo Ambayi, MD Havre Internal Medicine

Lisa R. Anderson-Mangan, LCPC Great Falls Licensed Clinical Professional Counselor

Steven D. Arbogast, DO Billings Neurology


Tiffany M. Bartolomei, LCPC Bozeman Licensed Clinical Professional Counselor

Zachary M. Bland, MD Billings Radiology

Theresa M. Blazek, LCPC Billings Licensed Clinical Professional Counselor

Gary A. Breetz, MD Billings Emergency Medicine

Karen E. Breetz, MD Billings Pediatrics

Robyn Butler-Hall, LCPC Billings Licensed Clinical Professional Counselor

Paul J. Byorth, MD Billings Ear, Nose, and Throat

Lee Anne Byrne, LCSW Whitefish Licensed Clinical Social Worker

Carol T. Cady, MD Missoula Allergy & Immunology

Jenifer D. Caldwell, PA Missoula Physician Assistant

Ammie M. Chapman, DC Billings Chiropractic

Susan E. Cheeseman, APRN Kalispell Nurse Practitioner



James W. Cherewatenko, PA Great Falls Physician Assistant

Denise M. Chumrau, PT Missoula Physical Therapy

Patrick J. Cindrich, MD Missoula Surgery, Neurological

Barry W. Cohan, MD Great Falls Endocrinology, Diabetes, & Metabolism

Jeremy O. Comin, DO Billings Anesthesiology

Gerard P. Connor, MD Billings Obstetrics and Gynecology

Barbara L. Cotter, LAC Great Falls Licensed Addiction Counselor

Kristopher G. Cunningham, MD Lewistown Family Medicine

Anthony R. Dal Nogare, MD Kalispell Internal Medicine

Kyle L. Dale, MD Missoula Radiology

Mark B. Darcey, CRNA Helena Certified Registered Nurse Anesthetist

Susanna L. Darr, NP Bozeman Nurse Practitioner

Michael C. DiCello, MD Bozeman Allergy & Immunology

Susan C. Dilatush, DC Missoula Chiropractic

Kathleen J. Durant, DC Red Lodge Chiropractic


Kristi J. Fischer, PT Billings Physical Therapy

Cathy M. Fisher, SLP Bozeman Speech Therapy

Jeremy J. Fleming, LCPC Butte Licensed Clinical Social Worker

Kelli R. Gibbs, PA Missoula Physician Assistant

Jon R. Gildea, DO Missoula Emergency Medicine


Sally G. Grunst, LCPC Billings Licensed Clinical Professional Counselor

Terry A. Hanson, LCPC Cut Bank Licensed Clinical Professional Counselor

James B. Harris, MD Dillon Radiology

Beth R. Henning, SLP Billings Speech Therapy

Tennille C. Hensley, PA Bozeman Physician Assistant

Brittnie A. Herbst, DPT Butte Physical Therapy

Janie M. Hett, DPT Corvallis Physical Therapy

Melissa C. Hulvat, MD Kalispell Surgery

Amy A. Jensen, SLP Billings Speech Therapy

Linda K. Johnson, MD Billings Obstetrics and Gynecology

Paul M. Johnson, MD Great Falls Family Medicine

Jennifer L. Jones, LCPC Missoula Licensed Clinical Professional Counselor

Holly Kadesh, LCPC Billings Licensed Clinical Professional Counselor

Terry G. Kennedy, MPT Bozeman Physical Therapy


Bernadette L. Kneefe, LCSW Missoula Licensed Clinical Social Worker

Beth K. Kramer, LCPC Whitefish Licensed Clinical Professional Counselor

Mary Ellen Krivonen, SLP Billings Speech Therapy

Jennifer L. Leach, LCPC Great Falls Licensed Clinical Professional Counselor

Alysan N. Long, DPT Bozeman Physical Therapy

Alysan N. Long, DPT Belgrade Physical Therapy

Theodore J. Losey, MD Kalispell Emergency Medicine

Kathryn A. Lysinger, MD Billings Pediatrics

Heather E. Maddox, MD Missoula Family Medicine

Michael L. Mahoney, MD Kalispell Family Medicine


Linda A. Malloy, OT Billings Occupational Therapy

Debbie D. Marler, LCPC Billings Licensed Clinical Professional Counselor

Bryan E. Martin, MD Great Falls Internal Medicine

Heidi M. Matlack-Larson, LCSW Butte Licensed Clinical Social Worker

Paul W. McCormick, LAC Helena Licensed Addiction Counselor

Kay K. McLain, LCPC Butte Licensed Clinical Professional Counselor

Margarete D. McLaren, CRNA Great Falls Certified Registered Nurse Anesthetist

Diane M. McLaverty, LCPC Missoula Licensed Clinical Professional Counselor



David Scott Meissner, PA Great Falls Physician Assistant

Michael J. Mitchell, MD Kalispell Anesthesiology

Christopher P. Montville, MD Billings Obstetrics and Gynecology

Kristi Lea Moore, PT Missoula Physical Therapy

Diane S. Morledge-Hampton, OT Billings Occupational Therapy

Jan M. Munday, LCSW Butte Licensed Clinical Social Worker

Dennis W. Muri, LCSW Billings Licensed Clinical Social Worker

Colleen L. Muzynoski, MD Billings Pediatrics

Rochelle T. Nielson, LCPC Bozeman Licensed Clinical Professional Counselor

Anthony J. Nieter, DC Kalispell Chiropractic


Rhiannon J. Ohman, DPT Belgrade Physical Therapy

Ashley M. Olsen, LCSW Bozeman Licensed Clinical Social Worker

Louise M. Orlich, LAC Butte Licensed Addiction Counselor

Mary E. Owens, NP Helena Nurse Practitioner

Amy K. Pakula, DPT Manhattan Physical Therapy

Kelley R. Parke, LCPC Eureka Licensed Clinical Professional Counselor

Thomas M. Parkhill, DPT Hamilton Physical Therapy

Kimberley M. Petersen, NP Missoula Nurse Practitioner

Jennifer L. Pierce, SLP Butte Speech Therapy

Lori H. Pike, LCSW Great Falls Licensed Clinical Social Worker

Julie C. Ponti, PA-C Kalispell Physician Assistant

Powell County Memorial Hospital Deer Lodge Hospital

Robert G. Putzker, DPT Helena Physical Therapy

Esther E. Racz, DPT Great Falls Physical Therapy

Roger S. Racz, DPM Great Falls Podiatry

Melanie K. Raffensperger, OT Great Falls Occupational Therapy

Douglas S. Reagan, MD Kalispell Orthopaedics

Sara A. Repola, APRN Kalispell Nurse Practitioner

James F. Richards, MD Billings Neurology

Evan L. Rick, LCPC Belgrade Licensed Clinical Professional Counselor

Michelle Rosario, MD Billings Obstetrics and Gynecology

Erin L. Russell, OT Belgrade Occupational Therapy

Aimee M. Rust, LCPC Billings Licensed Clinical Professional Counselor

Linda A. Saunders, DO Billings Family Medicine

Margaret R. Schlesinger, MD Missoula Rheumatology


Eric B. Schubert, MD Billings Surgery, Neurological

Erica R. Schuppe, OT Billings Occupational Therapy

Ralf Schurmann, DC Helena Chiropractic

Ryan P. Schwanke, MD Billings Family Medicine

Traci L. Sell, SLP Billings Speech Therapy

Travis E. Sherman, DPT Billings Physical Therapy

Catherine C. Silva, APRN Helena Nurse Practitioner

Adina J. Smith, PHD Bozeman Psychology

Bruce T. Smith, MD Helena Psychiatry

Shawn M. Smith, MD Butte Neurology

Tamera J. Smith, PT Bozeman Physical Therapy

Terry A. Smith, DO Plains Internal Medicine

Spectrum Home Solutions Great Falls I. V. Therapy


Richard L. Spillman, PA-C Billings Physician Assistant

Karin D. Steinke, PT Great Falls Physical Therapy

Janelle J. Sunvold-Palmer, NP Billings Nurse Practitioner

Charles C. Talton, MD Anaconda Family Medicine

Geoffrey B. Taylor, DO Great Falls Anesthesiology



Amy D. Thomas, DC Bozeman Chiropractic

Neil M. Thomas, DC Bozeman Chiropractic

Treasure State O & P Billings Medical Equipment

Kendrick A. Trostel, MD Billings Nephrology

Michael M. Ulrich, LCSW Billings Licensed Clinical Social Worker

Annie R. Ussin-Hunter, SLP Billings Speech Therapy

Julie K. Vollertsen, DC Helena Chiropractic

Kim W. Waterfall, MD Hamilton Family Medicine

Rebecca B. Weston, LCSW Missoula Licensed Clinical Social Worker

James L. Whittle, MD Great Falls Cardiovascular Disease

Thaddeus J. Widmer, LCSW Hamilton Licensed Clinical Social Worker

Christoph T. Woerlein, MD Great Falls Gastroenterology

Donald A. Zinke, CRNA Great Falls Anesthesiology

The following providers are no longer participating with the managed care provider network. Marci L. Barker, MD Great Falls Family Medicine

Kurt P. Benson, PHD Bozeman Psychology

Paul J. Byorth, MD Billings Ear, Nose, and Throat

Keith L. Cavanaugh, MD Billings Pediatric Pulmonology

James W. Cherewatenko, PA Great Falls Physician Assistant

Chris R. Duffy, DC Missoula Chiropractic

Erik A. Dufner, MPT Miles City Physical Therapy


Scott W. Falley, MD Helena Internal Medicine

Nancy J. Fitzpatrick, PA-C Butte Physician Assistant



Herbert I. Fried, MD Billings Surgery, Neurological

Jennifer K. Hall, MD Great Falls Pediatrics

Ronald K. Handlos, PA-C Billings Physician Assistant

Daniel E. Hesskamp, MD Helena Internal Medicine

Elizabeth S. Hill, LCSW Butte Licensed Clinical Social Worker

Elizabeth S. Hill, LCSW Philipsburg Licensed Clinical Social Worker

Shane A. Hill, MD Ronan Internal Medicine

James C. Hinshaw, MD Billings Obstetrics and Gynecology

Ben G. Hoffman, PA-C Billings Physician Assistant

Katherine P. Humphrey, PT Seeley Lake Physical Therapy

John A. Huntington, PA Billings Physician Assistant

David Neal Jackson, MD Billings Maternal and Fetal Medicine

Rashel Jeffrey, LCSW Missoula Licensed Clinical Social Worker


Bernadette L. Kneefe, LCSW Helena Licensed Clinical Social Worker

Mary A. Krenik, OT Billings Occupational Therapy

Kurt T. Kubicka, MD Helena Family Medicine

Kelli K. Lala, PA Billings Physician Assistant

Monica L. Maher, NP Billings Nurse Practitioner


John M. McCraney, MD Great Falls Anesthesiology

David Scott Meissner, PA Great Falls Physician Assistant

Rebecca A. Metcalf, PT Butte Physical Therapy

Angela M. Meyers, LCPC Great Falls Licensed Clinical Professional Counselor

Samuel J. Mitchell, MD Missoula Family Medicine

Sandra L. Nicholson, PA-C Great Falls Physician Assistant




Diane S. Page, LCSW Butte Licensed Clinical Social Worker

Douglas J. Parker, MD Billings Emergency Medicine

Andrew M. Rashkow, MD Great Falls Interventional Cardiology

J. Randall Rauh, MD Miles City Obstetrics and Gynecology

Julie A. Reil, MD Billings Family Medicine

Susan M. Reynolds, APRN Hamilton Nurse Practitioner

Suzanne M. Richards, LCSW Great Falls Licensed Clinical Social Worker

Michael J. Rider, DPT Helena Physical Therapy

Eric C. Roberts, MD Great Falls Physical Medicine & Rehabilitation

Sarah Rongstad, SLP Billings Speech Therapy


Erik L. Schroeder, MD Bozeman Sports Medicine

Teresa D. Smith, FNP Hamilton Nurse Practitioner

Stephen F. Speckart, MD Missoula Internal Medicine


Lawrence G. Splitter, DO Billings Preventive Medicine

Michael S. Strekall, MD Helena Family Medicine

Thomas G. Troop, MD Billings Family Medicine

Timothy W. Urell, DO Great Falls Family Medicine

Cynthia A. Van Beek, SLP Billings Speech Therapy

Douglas D. Van Marel, MD Miles City Internal Medicine

Robert B. Van Nice, MD Laurel Family Medicine

Sarah C. Wagner, PA-C Billings Physician Assistant

Sarah C. Wagner, PA-C Joliet Physician Assistant

Brett M. Williams, FNP White Sulphur Springs Nurse Practitioner

Christoph T. Woerlein, MD Great Falls Gastroenterology

Thomas W. Zavoral, MD Great Falls Emergency Medicine

Integrated Healthcare Management

www.bcbsmt.com An Independent LIcensee of the BLue cross And BLue shIeLd AssocIAtIon, An AssocIAtIon of the Independent BLue cross And BLue shIeLd pLAns.

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online service improvements inside this issue...online service improvements health care services...

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