Claims Modernization

Coming in 2027

New Montana Healthcare Programs Claims System

The Department of Public Health and Human Services (DPHHS) has contracted with Gainwell Technologies to implement a Claims, Encounter, and Financial (CEF) Solution for processing and paying Montana healthcare claims. The claims project kicked off in October 2024, with plans to roll out the new system in 2027.

Montana Healthcare Programs has relied on the current Medicaid Management Information Systems to process claims since 1984. The outdated technology has presented challenges in addressing the needs of our providers, members, and other system users.

Medicaid Enterprise Systems

The new Claims System is part of the DPHHS’s overall Medicaid Enterprise Systems (MES) initiative to modernize and improve systems supporting Montana Healthcare Programs. The new system will leverage modern, flexible, and adaptable solutions that will provide best-in-class capabilities to Montana Healthcare Programs providers, stakeholders, members, and staff.

Benefits coming in the new Claims System:

  • Near real-time adjudication of Montana Healthcare Programs claims
  • Increased automation and improved business processes
  • Ability to more quickly implement and automate Medicaid policy and rate changes

Stay Connected

DPHHS will inform providers about project status, timelines, training opportunities, and potential impacts on providers. To stay connected, please register your email address by following the instructions below.

Register your email address to receive Claims System updates and notifications in your inbox.

When the window opens, enter your email address and click the Submit button. If you are a new subscriber you will be prompted to confirm your email address by entering it again. You will also be given the option to set up a password. Once your information is entered on this screen click Submit.

A new screen will open with your options for Subscription Topics. Under Subscription Topics, scroll to the Medicaid section and select MPATH – New Claims System, then scroll to the bottom of the page and click Submit. The Success screen will open confirming that you have successfully subscribed.

To view or change preferences or delete the account, click the link above and enter your email address to access your Subscription Topics and subscriber preferences.

Contact Us

If you have questions, concerns, or feedback please contact HHSClaimsModernization@mt.gov.

 

Claim Jumper Registration

Claims Instructions webpage

Resources by Provider Type

There are currently no scheduled trainings for the new Claims System.

Register your email address to stay informed about the training schedule as the implementation date approaches.

Activity

Planned Start Date

Claims Project Kick-off

10/15/2024

Requirements Validation

10/17/2024

Design Phase

03/27/2025

Claims System Implementation

2027

 

There are currently no scheduled stakeholder meetings related to the new Claims System.