Following is information about prior authorization requirements for certain care categories for our Medicare Advantage and Healthy Montana Kids members.
Check eligibility and benefits first to confirm membership, verify coverage and determine whether prior authorization is required. For more information, refer to how to request prior authorization and recommended clinical review.
Prior authorization requirements
Blue Cross and Blue Shield of Montana reviews prior authorization requests for our Medicare Advantage members for the following care categories:
- Advanced imaging
- Musculoskeletal
- Sleep
- Medical specialty drugs
- Genetic testing
Submit requests via Availity® Essentials Authorizations & Referrals. To learn more, visit Availity Authorizations & Referrals. You can also submit requests by phone at 855-258-3489 or the phone number listed on the member's ID card.
The following service requires prior authorization through EviCore healthcare for our Medicare Advantage members:
Proton beam therapy
For more information about prior authorization through EviCore, refer to EviCore Provider Resources and select the BCBSMT health plan.
Prior authorization requirements for Healthy Montana Kids
The following services requires prior authorization for Healthy Montana Kids through Carelon Medical Benefits Management:
- Genetic testing
- Medical oncology
- Musculoskeletal – Spine procedures
Visit Carelon Medical Benefits Management for more details.
For information on checking eligibility, benefits, and prior authorization requirements, refer to Availity Essentials or call provider customer service for Healthy Montana Kids at 855-699-9907.
EviCore healthcare is an independent company that provides utilization review for select health care services on behalf of BCBSMT.
Carelon Medical Benefits Management is an independent company that has contracted with BCBSMT to provide utilization management services for members with coverage through BCBSMT.