BlueCross BlueShield
of Montana

10/13/15

Trina Health Of Montana
530 Montana St
Dillon, MT 59725

Dear Group:

Blue Cross and Blue Shield of Montana (BCB SMT) is pleased to welcome you into our provider

network(s). We are con?dent you will ?nd participation bene?cial to both you and your
patients.

Enclosed is a copy of the executed 

Participating Provider Agreement ("Agreement") for participation in the
BCB SMT Traditional, PPO, Federal Employee Program (FEP), the BlueCard Program, and
the BluePreferred PPO Networks

0 Managed Care Addendum

0 The Healthy Montana Kids (HMK) Provider Agreement

0 The Medicare Advantage Bene?t Program Agreement

Please remind your of?ce staff to bill directly for all services rendered to patients with
coverage. We will then compensate you based on each speci?c patient?s (member)
bene?ts. Your Provider Claims Register will indicate any patient responsibility for payment, and
you may bill your patient for that amount.

Be sure to include your NPI, on all claims to ensure accurate and timely claim processing. In
addition, contact us if your NPI, name, title, or mailing address listed above is incorrect. You may
also verify your directory listing at 

In accordance with HIPAA guidelines and in the spirit of administrative simpli?cation, you must
submit claims electronically. To learn more about submitting electronic claims, please contact
our electronic data interchange partner. Visit or call one of HeW?s toll
free numbers, 1-877-565-5457 or 1-877-463?8705.

Send correspondence to PO. Box 4309, Helena, MT 59604.
Be sure to check out the Provider Secure Services area of our website at It

provides a wealth of information to help you manage your practice online. You can con?rm
eligibility and bene?t information, view claims status and provider manuals with claim

560 N. Park Avenue PO Box 4309 Helena, Montana 59604-4309 

A Division of Health Care Service Corporation, a Mutual Legal Reserve Company, an lndependenl Licensee olthe Blue Cross And Blue Shield Association

processing requirements. Also available on our website are medical policies (click on Provider,
then Provider Manuals), and other helpful information.

If you have questions,- contact our Provider Network Representatives at 1-800-447-7828,
Extension 6100, or email 

Sincerely.

Wm

Paul Pedersen
Senior Director
Provider Contracting

Enclosure