Nurse First

What is Nurse First?
Nurse First is Montana Medicaid’s demand management program that empowers patients to become more active in their health care and provides assistance to providers in managing their care. The goal is to improve patient health status, assure access to quality care, and reduce avoidable visits and admissions. Nurse First consists of a nurse advice line, disease management and the Team Care Program.

Nurse First Advice Line. The advice line is a 24x7, toll free and confidential nurse triage line staffed by licensed-registered nurses. Eligible patients are encouraged to call when symptomatic, before making appointments or visiting an urgent care or emergency room. The nurses assess the symptoms, then provide a care recommendation to seek services at the appropriate time and level of intervention. Nurses do not diagnose nor provide treatment. The service is voluntary though strongly encouraged.

Benefits to providers:

  • Decreases evening/weekend on-call traffic

  • Reduces no show rates

  • Allows providers to focus on higher acuity patients

  • Safely reduces avoidable healthcare utilization

  • Less PHONE traffic

Disease Management. Disease Management emphasizes prevention of disease-related exacerbations and complications using evidence-based guidelines and patient empowerment tools. Our programs are designed to improve patient adherence to provider treatment plans and improve healthier living behaviors. Nurse First provides patients individualized counseling and education through face-to-face and telephonic interaction with specially trained registered nurses. Patients diagnosed with asthma, diabetes, congestive heart failure, pain and cancer may be eligible for the voluntary programs.

Team Care Program. Medicaid’s utilization control program that provides education and enhanced case management to patients with a history of seeking services when not medically necessary. The program promotes strict adherence to the proper use of medical services. Patients are enrolled with one provider, “locked-in” to one pharmacy to receive all Medicaid payable prescriptions, and are required to call the Nurse First Advice Line prior to seeking services. Participation in this program is mandatory.

For more information contact the Medicaid Help Line at 1-800-362-8312 or the Nurse First Program Officer at (406) 444-1518.