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Montana State Fund – Get Started
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Montana State Fund – Get Started
Providerflow Login
Medical Record Status
icompEDI LOGIN
Master Payor List
Our Services
Back
Clearinghouse Services
Provider Services
Vendor Solutions
Claims & Bill Automation
SaaS Solutions
Payments
Digital Mailroom
AP Automation
About us
Back
What we do
Compliance & Security
Business Continuity
Leadership
Resources
Back
News
Blog
FAQ
Careers
Brochure Library
Support
Support
Contact
icompEDI LOGIN
Master Payor List
Our Services
Back
Clearinghouse Services
Provider Services
Vendor Solutions
Claims & Bill Automation
SaaS Solutions
Payments
Digital Mailroom
AP Automation
About us
Back
What we do
Compliance & Security
Business Continuity
Leadership
Resources
Back
News
Blog
FAQ
Careers
Brochure Library
Support
Contact
Montana State Fund – Get Started
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Montana State Fund – Get Started
Get Started Submitting Electronically
First Name
Last Name
Email Address
Phone Number
Company Name
Website
Primary Billing Contact
Primary Billing Phone
Street Address
Address Line 2
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Please select...
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Zip Code
Tax I.D.
Type of Submitter
Please select...
Ancillary Medical Services
Billing Agent/Service
Clearinghouse
Healthcare Provider
Health System
Hospital
PBM/Pharmacy
PPO/MCO/MPN/HCO/PPN/HCN
Practice Management System
Other
Format Used (choose all that apply)
ADA 2006 Form
ASC X12 5010 A1 Health Care Claim: Professional (837)
ASC X12 5010 A2 Health Care Claim: Institutional (837)
ASC X12 5010 A2 Health Care Claim: Dental (837)
CMS 1500 Image File
Dental (ADA 2012)
NCPDP D.0
NCPDP UCF/WC Form
Paper Non-Standard Form
Proprietary Format
UB04 Image File
UCF Form
Web Form
Estimated number of workers' compensation bills sent to payers each month
Practice Management System
Can this system export bill data within ANSI 837 format or just to a printer?
Estimated number of auto medical bills sent to payers each month
Do you currently utilize a Group Health Clearinghouse for private/group health billing?
Please select...
Yes
No
Current clearinghouse vendor
How are your current medical records stored?
Please select...
EMR/EHR
Paper
Scanned and saved as PDF's on server
Other
If other, please explain.
What EHR do you currently use?
Comments / Additional Info
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