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Passport to Health

General Passport Information (07/2014)

What Is Passport?
Useful information for providers on the Passport to Health Program and how to obtain Passport approval. (07/2014)

Passport Q&A
Get answers to the most commonly asked Passport questions. (08/2013)

Passport Publications (10/2013)

Other Resources (08/2013)

Forms (06/06/2014)
  • Health Improvement Program Provider Referral Form (06/2014)
    Providers should fill out this form and fax it to the 406-444-1861.
  • Passport Agreement Amendment to Add Providers (08/2013)
    Providers should fill out this amendment to the Passport provider agreement when adding new providers to a group practice.
  • Passport Agreement Amendment to Increase Caseload Capacity (08/2013)
    Providers should fill out this amendment to the Passport provider agreement when increasing member caseload capacity.
  • Passport Change Form (07/2014)
    Medicaid/HMK Plus members can use this form to change Passport providers. Provider changes will not take effect until the month following the request.
  • Passport Referral Form (07/2013)
    Passport providers may use this form when providing a referral for their members to another provider.
  • Passport to Health Provider Agreement (02/2014)
    Providers who wish to become a Passport provider should be an active Medicaid provider and have primary care within his/her professional scope of practice. This agreement is section of the overall Montana Health Care Programs enrollment package and the page numbering reflects that document.
  • W-9 Form (12/2013)
    Providers must submit a W-9 form when changing their physical address. This is the approved form to use.

Archived Passport Newsletters and Other Material