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 The outdated technology has presented challenges in addressing the needs of our providers, members, and other system users.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
- Register to subscribe to the Claim Jumper, Montana Healthcare Programs monthly provider publication.
Claims Instructions webpage
- Please visit the Claim Instructions page on the Montana Healthcare Programs Provider Information website to access current claims submission instructions, forms, and other claims resources.
Resources by Provider Type
- Access your provider type on the Resources by Provider Type page on Montana Healthcare Programs Provider Information website to view your applicable program manuals, fee schedules, provider notices, and other resources pertaining to your 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.