The HELP Plan

During the 2015 Legislative session, the Montana Legislature enacted Senate Bill 405, the Montana Health and Economic Livelihood Partnership (HELP) Act, which expands health care services for state residents between the ages of 19 and 64, whose household income is 138% or less of the federal poverty level. This Medicaid expansion program is referred to as the "HELP Plan". The HELP Plan creates affordable health plan coverage and access to providers for this segment of the State's population. Blue Cross and Blue Shield of Montana (BCBSMT) was selected as the third party administrator (TPA) of the HELP Plan.

Effective January 1, 2018, the administration of the HELP Plan will be transitioned from Blue Cross and Blue Shield of Montana (BCBSMT) to Conduent (Previously known as Xerox). Customer Service inquiries, eligibility inquiries, claims submission, and claims processing for dates of service in 2016 and 2017 will continue to be handled by BCBSMT through December 31, 2018.

Any claims for services rendered in 2018 that are submitted to BCBSMT will be rejected and a letter will be sent to the provider notifying them the participant is not eligible.

As details of the transition are finalized, additional information will be provided.

This project is funded in whole or in part under a contract with the Montana Department of Public Health and Human Services. The statements herein do not necessarily reflect the opinion of the Department.

Who Is Eligible?

Individuals who make up to 138 percent of the federal poverty level. That works out to roughly $16,000 a year for one person or $33,000 for a family of four. Additionally, to be eligible, individuals must be:

  • Ages 19 to 64
  • Montana residents
  • Not enrolled in or qualified for Medicare
  • Not pregnant when applying for coverage

Claims

Claims for specific services will be administered by the Montana Department of Health and Human Services (DPHHS), while others will be administered by BCBSMT.

Services for which DPHHS will administer and pay the claims:

  • FQHC
  • RHC
  • Dental
  • Eyeglasses
  • IHS and tribal health services
  • Diabetes prevention services
  • Any transportation
  • Prescription drugs
  • Home infusion
  • Hearing aids
  • Audiology

Submit hard copy claims to DPHHS at the following address:

Claims Processing
P.O. Box 8000
Helena, MT 59604

Excluded provider types/services include:

  • Naturopathic physicians
  • Chiropractors
  • Nursing homes
  • Inpatient hospice
  • Long Term Care
  • Chronic care institutions

Submit hard copy claims to BCBSMT at the following address:

BCBSMT HELP Medicaid Claims Correspondence
P. O. Box 3387
Scranton, PA 18505

The Provider Electonic Payor ID for the HELP Plan is - 66004

The HELP Plan Alpha Prefix is YDM

The HELP Plan will use Claims Extend bundling

Eligibility & Benefits Requests (270) and Claim Status Inquiries (276) for dates on or after 1/1/16 can now be submitted electronically using Payer ID BCBMT and the subscriber ID should include the 3 character alpha prefix (YDM) followed by the numeric member ID/Medicaid ID. If you have any questions, please contact HeW Support at 1-877-565-5457, Option 1.

Providers can also enroll to receive Electronic Remittance Advices (ERA) and Electronic Funds Transfers (EFT) for this payer. Effective 6/17/16, all BCBSMT providers already receiving ERAs and EFTs were automatically enrolled to receive the ERA and EFT for this new payer and no additional enrollment is necessary. If you are not currently receiving ERAs/EFTs and would like to enroll, please contact HeW Support at 1-877-565-5457, Option 1.

For newborn babies, please hold claims until the baby is set up with standard FFS Medicaid. Claims will not process under the mother. The newborn 31 day rule is state statute and does not apply to Medicaid or the HELP Plan.

Fee Schedules

BCBSMT allowances for services mirror the Montana Medicaid fee schedules .

Join the Network

To join the BCBSMT HELP Plan Network a provider must be credentialed by BCBSMT and meet screening and enrollment requirements outlined under 42 Code of Federal Regulations 455 Subpart E.

Providers that have completed the screening and enrollment requirements for Medicare, Montana Medicaid, or another State’s Medicaid or CHIP program, or are currently in one of these agency’s process, need not duplicate the screening and enrollment efforts.

HELP Plan network participation can be accomplished thru executing an amendment to BCBSMT’s current network participation agreement.

Below you will find the HELP Contract Amendment and a Provider List Form. Sign and date the agreement and complete the provider roster list, indicating each provider’s name in your organization, NPI and whether he/she is currently enrolled in Medicare, Montana Medicaid or another state’s Medicaid or CHIP Program. Complete and submit both of these forms as directed below.

For each provider not currently enrolled in Medicare, Montana Medicaid or another state’s Medicaid or CHIP Program, also complete and submit the “HELP Enrollment Application Form” .

Complete the following forms according to the above instructions:

For providers not currently particpating in the BCBSMT networks, in addition to completing the above forms, visit our General “How to Join” the BCBSMT network page.

Please complete and return all of the requested documents above via any of the following means:

  • Fax 406-437-7879
  • e-mail
  • U.S Postal Service
    BCBSMT Network Management - HELP Network
    P.O. Box 4309,
    Helena, MT 59604

If you have any questions, please do not hesitate to contact BCBSMT’s Provider Network Representatives at 800/447-7828, Extension 6100, or by email.

Member Benefits

Benefits for services provided by out-of-network providers are not available except for urgent and emergent care or pre-authorized services.

Participants of the HELP Plan whose income is above 100% of the Federal Poverty Level (FPL) are required to pay a monthly premium. The monthly premium cannot exceed two (2%) of the yearly household income.

Copayments are required for certain services. The copayment amounts vary dependent upon the participant’s income level. Please refer to the Participant Guide for the services requiring copayments and the copayment amounts.

Participants receive a credit toward copayments equal to the total owed premium amount for the quarter. Copayments will not be charged until the credit is met.

Participants are required to pay a copayment to the provider after the claim has been processed. Providers may not charge copayments to the participant until the claim has processed through the claims adjudication process and the provider has been notified of payment and amount owing.

The maximum out of pocket amount cannot exceed five (5%) of the total household income. This is calculated on a quarterly basis.

Information on eligibility, benefits and claims status may be obtained by calling 877-296-8206.

Resources

HELP Plan Provider Manual

The Blue Cross and Blue Shield of Montana (BCBSMT) HELP Plan Provider Manual contains information to assist your office with day-to-day business operations involving BCBSMT and its Participants.


Preauthorization

Behavioral Health and Medical Services

  • Fax number 406-437-5850
  • Phone number 877-296-8206

MT HELP Best Practices PDF Document.

Preauthorization Services PDF Document.

MT HELP Plan Preauthorization Form PDF Document.


Related Information:

Montana's HELP program

Montanans will be able to apply several ways, pending timely approval by CMS:

For questions or concerns reach out to your Provider Network Representative.

Updates