Eligibility and Benefits

Patient eligibility and benefits should be verified prior to every scheduled appointment. Eligibility and benefit quotes include membership verification, coverage status and other important information, such as applicable copayment, coinsurance and deductible amounts. It's strongly recommended that providers ask to see the member's ID card for current information and photo ID in order to guard against medical identity theft. When services may not be covered, members should be notified that they may be billed directly.

Checking Online

Providers are strongly encouraged to use our Secure Provider Portal for eligibility and benefit verifications. Users can access printable results that include up to date benefit information.

  • Patient/Subscriber information
  • Group Number
  • Group Name
  • Plan/Product
  • Current Effective Dates
  • Copayment*
  • Deductible (original and remaining amounts)
  • Out-of-pocket (original and remaining amounts)
  • Coinsurance
  • Limitations/Maximums*
  • Preauthorization indicators and contacts

Exceptions

For out-of-state Blue Cross and Blue Shield members, call the BlueCard® Eligibility Line at 800-676-BLUE (2583) for eligibility and benefit verifications. Learn more about BlueCard. PDF Document.

For Federal Employee Program (FEP) members, eligibility and benefits can be obtained by calling 800-634-3569.

Questions

Email Provider Relations at hcs-x6100@bcbsmt.com. Be sure to include your name, direct contact information, tax ID or billing NPI.

Verification of eligibility and/or benefit information is not a guarantee of payment. Benefits will be determined once a claim is received and will be based upon, among other things, the member's eligibility, any claims received during the interim period and the terms of the member's certificate of coverage applicable on the date services were rendered.

* These benefit categories will only appear if applicable to the services being rendered.