Prior Authorization

Prior authorization is a process BCBSMT uses to make coverage decisions in accordance with medical policy and group or member contracts for a service, supply, drug, or device (hereafter, a service) used to diagnose or treat an illness or condition. 

BCBSMT recommends prior authorization for services if a provider is uncertain about coverage or if BCBSMT might not consider the service medically necessary.  Refer to the Prior Authorization Medical Policy  for more information.  A complete list of codes requiring special processing and forms are listed below. 

Send prior authorization requests to:

Blue Cross and Blue Shield of Montana
Medical Review/Prior Authorization
PO Box 4309
Helena, MT 59601
Fax: 406.444.8451

Advanced Member Notfication

Advance Member Notification (AMN) refers to the process in which a provider informs a member that a service, supply, device, or drug (hereafter, a service) is not likely to be considered for compensation by BCBSMT prior to the service being performed. Through the AMN process, the member is able to understand the financial implications of receiving the service, and the participating provider is able to alter the financial liability of a service that would be denied as not medically necessary. The AMN process only applies to professional services. This policy does not apply to hospital-based services, skilled nursing facilities, or home health services.

AMN forms are listed below. 

Codes Requiring Special Processing PDF 214kb

Prior Authorization Form PDF 29kb
IV Therapy Prior Authorization Form PDF 28kb
PET Scan Prior Authorization Form PDF 31kb

AMN Health Care Items and Services PDF 37kb
AMN Laboratory Tests PDF 37kb