How to Request Preauthorization, Predetermination
The following outlines the process for providers to submit preauthorization requests.
Submitting Preauthorization Requests
Step 1:Confirm if preauthorization is required using Availity® or your preferred vendor. This will determine if preauthorization will be obtained through us or a dedicated vendor.
Step 2:Get preauthorization:
Services requiring preauthorization through BCBSMT:
- Submit via Authorizations & Referrals . To learn more, visit Availity Authorizations & Referrals.
- Call the phone number listed on the member’s ID card.
Services requiring preauthorization through AIM Specialty Health® (Jan. 1, 2021 and after):
- Submit requests via the AIM Provider Portal
- For Preauthorizations, Call 1-844-377-1285
- For Technical Support, Call the AIM Contact Center at 1-800-859-5299
- Use this AIM Specialty Health Tip Sheet for more information and resources
Services requiring preauthorization through eviCore®:
- Submit requests via the eviCore Healthcare Web Portal
- Call toll-free at 1-855-252-1117
- Refer to the eviCore page for more information
Services requiring preauthorization for Healthy Montana Kids through BCBSMT:
- Call toll-free 1-855-699-9907
- Fax line 1-855-610-5684
Services requiring preauthorization for Federal Employee Program:
- Call toll-free at 1-877-885-3751.
Services requiring preauthorization for Medicare Advantage:
- Call toll-free 1-877-774-8592
- Fax line 1-855-874-4711.
Step 3:Provide the following information:
- Patient’s medical or behavioral health condition
- Proposed treatment plan
- Date of service, estimated length of stay (if the patient is being admitted)
- Patient ID and name/date of birth
- Place of treatment
- Provider NPI, name and address
- Diagnosis code(s)
- Procedure code(s) (if applicable)
Step 4:After the request is submitted, the service or drug is reviewed to determine if it:
- Is covered by the health plan, and
- Meets the health plan’s definition of “medically necessary.”
The results are then sent to the provider and member. If you have questions about the response, contact Utilization Management or the authorizing vendor.
Preauthorization/Precertification Information for BlueCard (Out-of-Area) Members
Use our Provider Router to obtain information about preauthorization/precertification for members of other Blues Plans (out-of-area members). This tool will route you directly to the other Plan's website to view specific preauthorization/precertification requirements for an out-of-area member. Click the link below to open the tool and simply enter the member's Alpha Prefix (first three letters of the identification number) located on their ID Card to be routed to the appropriate Plan.
You can also refer to the Electronic Provider Access (EPA) FAQs for additional information.
Submitting Predetermination Requests for Commercial Plans
How to Submit a Request for Review via Availity:
- Log in to Availity
- Select Claims & Payments from the navigation menu
- Select Attachments – New
- Within the tool, select Send Attachment then Predetermination Attachment
- Download and complete the Predetermination Request Form
- Complete the required data elements
- Upload the completed form and attach supporting documentation and photos (if required for review)
- Select Send Attachment(s)
If you do not have access to Availity, complete the Predetermination Request form and mail or fax it to BCBSMT.
- Do you need Predetermination Forms? Go to our Provider Forms page.
- Send predetermination requests to the address or fax on the form
How to Submit a Request for Review via Fax:
- To request a Predetermination by fax and/or mail, please complete the Predetermination Request Form . All applicable fields are required. If any information is not provided, this may cause a delay in the Predetermination process. (Requests received without the member/patient's group number, ID number, and date of birth cannot be completed and may be returned.)
- Fax information for each patient separately to BCBSMT Fax #: 1- 866-589-8256.
- Always place the Predetermination Request form on top of other supporting documentation. Please include any additional comments if needed with supporting documentation.
- Do not send in duplicate requests, as this may delay the process.
- Per Medical Policy, if photos are required for review, the photos should be mailed to the address indicated on the Predetermination Request form and not faxed. Faxed photos are not legible and cannot be used to make a determination.
- Regarding major diagnostic tests, please include the patient's history, physical and any prior testing information.