2019 News and Updates

Introducing a New Preauthorization Submission Tool via Availity® Provider Portal

Dec. 25, 2019

Blue Cross and Blue Shield of Montana (BCBSMT) is excited to introduce a brand-new online preauthorization application via the Availity Portal, called Authorizations (HIPAA-standard 278 transaction). This new and more convenient functionality will be available to providers as of Jan. 30, 2020, making it faster and easier to submit and receive confirmation from BCBSMT. For Federal Employee Program®; (FEP®), providers should continue to use their current preauthorization process until this the new application becomes available in the near future.

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Reminder: Medicare Providers May Not Bill Participants in the Qualified Medicare Beneficiary Program

Dec. 19, 2019

As a Medicare provider, you may not bill individuals enrolled in the Qualified Medicare Beneficiary Program (QMB), a federal Medicare Savings Program.

Individuals enrolled in QMB are dual eligible beneficiaries, which means they are eligible for both Medicare and Medicaid. As a State Medicaid benefit, QMB covers the Medicare premiums, deductibles, coinsurance and copayments of QMB beneficiaries. QMB beneficiaries are not responsible for Medicare cost-sharing, or out-of-pocket costs.

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Reminder: Out-of-Network Medicare Providers Can Treat Group Medicare Advantage Open Access (PPO) Members

Dec. 18, 2019

As a Medicare provider, you do not need to have a contract with Blue Cross and Blue Shield of Montana (BCBSMT) to treat Blue Cross Group Medicare Advantage Open Access (PPO)SM members.

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National Coordination of CareSM Program to Serve Group Medicare Advantage PPO Members

Dec. 18, 2019

Beginning Jan. 1, 2020, we will participate in a new Blue Cross and Blue Shield Association National Coordination of Care program to help improve care and services for Blue Cross Group Medicare Advantage (PPO)SM (MA PPO) members nationwide. This program also will help streamline administrative processes for providers.

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2020 Holiday Schedule Reminders (for 835 and 837 transactions)

Dec. 13, 2019

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Blue Cross and Blue Shield MAPD 30 Day Facility Readmission

Dec. 13, 2019

Consistent with the Centers for Medicare & Medicaid Services (CMS) guidelines, beginning March 1, 2020, Blue Cross and Blue Shield of Montana (BCBSMT) will review acute hospital claims, to determine if such readmissions to the same facility within 30 days of discharge are related and may deny payment to the facility for related admissions. These changes help support quality of care improvement efforts by linking payment to the quality of facility care for our Blue Cross and Blue Shield MAPD (PPO)SM members.

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Pharmacy Program Updates: Quarterly Pharmacy Changes Effective Jan. 1, 2020 – Part 2

Dec. 12, 2019

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Notification of Annual Benefit Updates

Dec. 06, 2019

Blue Cross and Blue Shield of Montana (BCBSMT) will be updating member files with annual benefit changes over the next several weeks. As always, we encourage you to verify your patients' coverage first, using Availity® or your preferred vendor portal.

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Antibiotic Use in Outpatient Settings

Dec. 03, 2019

Over prescription of antibiotics has increased antibiotic resistance. We can work together to combat antibiotic resistance and appropriately prescribe these important medications. According to a Pew1 Charitable Trust report regarding Antibiotic Use in Outpatient Settings , 30% of antibiotics prescribed are found to be unneeded for treating conditions like viral illnesses and asthma exacerbation.

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Annual Reminder: Medicare Outpatient Observation Notice Required

Nov. 26, 2019

As of March 8, 2017, hospitals and Critical Access Hospitals (CAH) must give the standardized Medicare Outpatient Observation Notice (MOON) to people who receive Medicare benefits and are observed as outpatients for more than 24 hours. This includes people with Blue Cross Medicare Advantage (PPO)SM, Blue Cross Group Medicare Advantage (PPO)SM and Blue Cross Group Medicare Advantage Open Access (PPO)SM health plans.

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Collaborating to Reduce Opioid Abuse

Nov. 20, 2019

At Blue Cross and Blue Shield of Montana we pledge "to do everything in our power to stand with our members in sickness and health". We take that very seriously. That is why we have started a new program to help you care for members who may be at risk for an opioid-related adverse event. We hope that by collaborating with members and providers, we can find ways to reduce risk and promote patient safety.

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New Form: Coordinating Care Among Behavioral Health and Medical Providers

Nov. 14, 2019

Coordinating care between behavioral health and medical providers helps deliver the best care for our members. Our surveys consistently show providers appreciate care coordination. Consulting and referring providers should share information such as diagnoses, medications, treatment plans and recommendations. To help providers request information from each other. Blue Cross and Blue Shield of Montana (BCBSMT) has created a simple form PDF Document that providers can use to improve care coordination.

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Medicare Advantage: Electronic Payment Summary Now Available for 835 ERA Receivers

Nov. 12, 2019

This notice applies to providers submitting claims to Blue Cross and Blue Shield of Montana(BCBSMT) for Blue Cross Medicare Advantage (PPO)SM members.

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Medicare Advantage: Interpreting the 'PLB' Segment on the 835 Electronic Remittance Advice (ERA)

Nov. 07, 2019

The below announcement applies to providers submitting claims for the following Blue Cross and Blue Shield of Montana (BCBSMT) government programs members:

  • Blue Cross Medicare Advantage (PPO)SM

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New Online Enrollment Process for 835 EFT & ERA through the Availity® Provider Portal

Nov. 07, 2019

A new online Electronic Funds Transfer (EFT) and Electronic Remittance Advice (ERA) setup tool is coming soon to Blue Cross and Blue Shield of Montana (BCBSMT). This new capability will be available in the Availity Provider Engagement Portal using the multi-payer Transaction Enrollment tool. BCBSMT's current online EFT and ERA enrollment option available in our Availity Payer Spaces section will be removed once the transition to the new tool is complete.

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Medicare Advantage: New Claim Status Tool via Availity® Provider Portal

Nov. 07, 2019

This notice applies to providers rendering services for the following Blue Cross and Blue Shield of Montana (BCBSMT) members:

  • Blue Cross Medicare Advantage PPOSM

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New Wellbeing Management and Health Advocacy Solutions Programs Help Members Lead Healthier Lives

Nov. 06, 2019

A complex combination of factors affects each person's health journey. Some of our members are navigating critical health concerns. They may be struggling to combat chronic conditions such as diabetes, obesity, substance abuse disorder or depression. Our Wellbeing Management and Health Advocacy Solutions programs help empower our members to improve their own health and wellness.

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Pharmacy Program Updates: Quarterly Pharmacy Changes Effective Jan. 1, 2020 – Part 1

Nov. 01, 2019

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Well-Child Visits Within the First 15 Months of Life (W15)

Oct. 31, 2019

At Blue Cross and Blue Shield of Montana, we are committed to offering support and resources to physicians to achieve the highest level of care possible for their patients, our members, in order to achieve the best possible health outcomes. Thank you for your dedication to ensure that your patients receive exceptional care.

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eviCore Benefit Preauthorization Training for Advanced Imaging, Genomic Lab, Joint/Spine/Pain and Sleep Management Services

Oct. 30, 2019

eviCore healthcare (eviCore) is offering optional provider orientation sessions to review how to submit benefit preauthorization requests. Sessions will cover benefit preauthorization requests for the following services:

  • Advanced Imaging
  • Genomic Lab
  • Musculoskeletal (MSK) Joint/Spine/Pain Services
  • Sleep Management and Related Equipment Services

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Be Covered – Increasing Coverage for the Uninsured and Underinsured

Oct. 29, 2019

Around 86,000 people in Montana do not have health insurance. Approximately half qualify for Medicaid or a federal subsidy to help reduce the cost of coverage. Affordable care and better health outcomes start with health care coverage.

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What You Need to Know About the 2019-2020 Flu Season

Oct. 25, 2019

The Centers for Disease Control and Prevention (CDC) recommends yearly flu shots for all patients 6 months and older without vaccine contraindication. Providers may administer any U.S. Food and Drug Administration (FDA) approved, age-appropriate flu shot. Remember to review the current flu vaccine product table PDF Document for the most recent updates on available products and their approved age ranges.1

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Group Medicare Plans Get New Names and ID Cards Starting January 1, 2020

Oct. 25, 2019

Beginning Jan. 1, 2020, you may notice new names and ID cards for two of our group Medicare plans. In addition to Blue Cross Medicare AdvantageSM plans for individuals, you may see the following new names for group plans offered by our members’ benefit administrators. While the plan names have changed, your experience as a provider will be the same. Members will have no change to benefits due to the plan name changes.

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Availity® Remittance Viewer Tool Upgrade

Oct. 24, 2019

The Availity Remittance Viewer tool has been upgraded to better assist you with viewing, searching and reconciling Electronic Remittance Advices (835 ERA). Remittance Viewer is available to providers who are enrolled to receive 835 ERA files from Blue Cross and Blue Shield of Montana (BCBSMT). If you have not yet enrolled with BCBSMT, you can register online via the Availity Portal. Refer to the Availity ERA tip sheet PDF Document for enrollment instructions.

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Effective January 1, 2020: Change to NDC Fee Schedule for Medication Fulphila and Udenyca

Oct. 24, 2019

The medications Fulphila (J5108), and Udenyca (J5111) will have an update in the allowable effective January 1, 2020. The update for these codes will be reflected in the BCBSMT professional NDC fee schedule available on the BCBSMT Secure Provider Portal.

If you have any questions, please contact your Provider Network Consultant.

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BCBSMT to Review Implant Claims from Stand-Alone ACSs

Oct. 23, 2019

At Blue Cross and Blue Shield of Montana (BCBSMT), we are changing the way claims are reviewed for implants performed at free-standing ambulatory surgery centers (ASCs). EquiClaim currently reviews implant claims submitted by hospitals and hospital outpatient departments for services provided to our members. As of Dec. 15, 2019, EquiClaim will also provide post-payment review for all ASC claims with implant charges.

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Change in Advance Member Notification Process Effective 1/1/2020

Oct. 23, 2019

To improve cost transparency for our Members and provide a more efficient process for our Participating Providers, Blue Cross and Blue Shield of Montana (BCBSMT) is making changes to our Advance Member Notification (AMN) process. These changes will apply to all lines of BCBSMT business except for Medicare Supplement and Medicare Advantage, effective 1/1/2020.

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Addition of New Preauthorization Requirements for Montana Members

Oct. 23, 2019

There are important changes to the preauthorization requirements for some of your Blue Cross and Blue Shield of Montana (BCBSMT) patients with fully insured benefit plans and self-funded group benefit plans. Beginning January 1, 2020, upon the members’ renewal date, preauthorization will be required or expanded for these drug therapies:

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Make Sure Your National Provider Identifier (NPI) is Accurate

Oct. 09, 2019

Important Reminder: Review your provider National Provider Identifier (NPI) information, ensure it is accurate and make any necessary changes.

 

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Cotiviti Denial Rationale and Additional Action(s) Now Available in the Claim Research Tool

Oct. 03, 2019

In the August 2019 News and Updates notice we announced new and exciting functionality coming to the Claim Research Tool (CRT) on the Availity portal. Listed below are the CRT enhancements implemented by Blue Cross and Blue Shield of Montana (BCBSMT) to improve your online claim status experience. As a reminder, the CRT is not currently available for government programs (Medicare Advantage) claims.

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Changes to Medicare Advantage Payment Models for Skilled Nursing Facility and Home Health Care Claims

Oct. 02, 2019

The Centers for Medicare & Medicaid Services (CMS) is launching new payment models for skilled nursing facilities and home health care. Blue Cross and Blue Shield of Montana (BCBSMT) is aligning its payment models with CMS for Medicare Advantage claims.

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Medical Policy Reminder Regarding Robotic Assistance in Surgery

Oct. 02, 2019

The Blue Cross and Blue Shield of Montana (BCBSMT) Commercial medical policy Endoscopic, Arthroscopic, Laparoscopic, and Thoracoscopic Surgery SUR701.014 contains criteria that explains robotic assistance is not considered medically necessary. "The surgical instruments, devices and adjuncts a surgeon selects for performing a surgical procedure are regarded as integral to achieving a successful outcome for that procedure. Robotic assistance, as an adjunct to the primary procedure, is considered not medically necessary."

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FEP Blue Focus Prior Authorization Reminder

Sep. 30, 2019

Thank you for serving our Federal Employee Program® (FEP) Blue Focus members. As a reminder, prior authorization is required for some services for FEP Blue Focus members. The services include high tech imaging studies, such as magnetic resonance imaging (MRI), magnetic resonance angiography (MRA), computed tomography (CT), computed tomography angiography (CTA), nuclear cardiology and position emission tomography (PET) scans.

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Care for Patient Long-Term Health: Measure and Document Body Mass Index (BMI)

Sep. 30, 2019

Maintaining a healthy weight is key to reducing the risk of high blood pressure, high blood cholesterol and type 2 diabetes. Reducing the risk of these factors decreases the risk of heart disease and stroke. Body Mass Index (BMI) is a measurement that screens for weight categories that may lead to health problems. Measuring and documenting your patients’ BMI can help you care for their long-term health.

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A Change in the Coding of Physical Medicine Service Units

Sep. 27, 2019

As of July 22, 2019 we changed our time measurement standard for billing physical medicine services. We will now follow the American Medical Association (AMA) guidelines for time-based services. These are time-based codes within the Physical Medicine and Rehabilitation section of the Current Procedural Terminology (CPT) code book.

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Bluecard® Alert: Itemized Bill May be Required For Some Inpatient Claims, Effective January 1,2020

Sep. 27, 2019

Beginning January 1, 2020, BCBSMT will lower the itemized claim review threshold for out-of-area member claims to $200,000 and up.  Additionally, audits may occur for claims below this dollar threshold as needed.

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Pharmacy Program Updates: Quarterly Pharmacy Changes Effective Oct. 1, 2019 - Part 2

Sep. 12, 2019

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New and Exciting Functionality Coming to the Claim Research Tool (CRT) via Availity® Provider Portal

Aug. 22, 2019

Effective Aug. 26, 2019, Out-of-Network Line Level Detail Available in CRT

  • Providers can view out-of-network patient responsibility in the service line details when using the Claim Research Tool (CRT) in the Availity Portal. This enhancement will help providers identify if the patient liability was applied to the out-of-network co-payment, coinsurance, and/or deductible.

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Changes to Prior Authorization Requirements for BCBSMT Medicare Advantage Patients

Aug. 01, 2019

There are important changes to the prior authorization requirements for your Blue Cross and Blue Shield of Montana (BCBSMT) patients enrolled in BCBSMT’s Medicare Advantage program. Beginning Sept. 1, 2019, prior authorization through eviCore healthcare, an independent specialty medical management company, will no longer be required for:

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Pharmacy Program Updates: Quarterly Pharmacy Changes Effective Oct. 1, 2019 – Part 1

Jul. 31, 2019

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Reminder: Verify Procedure Code Preauthorization Requirements Online

Jul. 23, 2019

In the Dec. 2018 News & Updates we announced a new online capability that allows providers to verify preauthorization requirements for specific Current Procedural Terminology (CPT) or Healthcare Common Procedure Coding System (HCPCS) codes via an eligibility and benefits inquiry in the Availity® Provider Portal. Since implementation many updates have been made to improve articulation.

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Notice of Change to Preservice Appeals Process for Medicare Patients

Jul. 19, 2019

There are important changes to the preservice appeals process for Blue Cross and Blue Shield of Montana (BCBSMT) patients enrolled in Medicare programs.

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Member Letters Have a New Look

Jul. 17, 2019

Service request approval and denial letters have a fresh, updated look. Blue Cross and Blue Shield of Montana (BCBSMT) knows your time is valuable. We eliminated nonessential information to make member letters straightforward and simple. The new layout is now in color and includes symbols that are easy to understand. Both you and your patient can find the information you need fast. As always, you will be copied on member letters about service request approvals and denials. Keep a lookout for the redesigned member letters.

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Living365® “Managing Your Asthma/COPD” Health Education Classes Available for Select Blue Cross and Blue Shield of Montana Members

Jun. 17, 2019

To support our members with asthma or chronic obstructive pulmonary disease (COPD), Blue Cross and Blue Shield of Montana (BCBSMT) has partnered with Albertson’s to offer LIVE Asthma/COPD Management Classes through July 2019. Through our Living365® program, these educational classes are being offered at no additional cost for our members with a Medicare Advantage plan.

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Reporting On-Demand Application Now Available for Medicare Advantage via Availity® Provider Portal

Jun. 11, 2019

Blue Cross and Blue Shield of Montana (BCBSMT) has updated its Specialty Drugs Preauthorization List for Infusion Site of Care. Two codes have changed. The changes reflect these drugs’ new replacement Healthcare Common Procedure Coding System (HCPCS) codes assigned by The Centers for Medicare & Medicaid Services (CMS):

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Changes to Specialty Drugs Preauthorization List: Always check Preauthorization Requirements

Jun. 11, 2019

Blue Cross and Blue Shield of Montana (BCBSMT) has updated its Specialty Drugs Preauthorization List for Infusion Site of Care. Two codes have changed. The changes reflect these drugs’ new replacement Healthcare Common Procedure Coding System (HCPCS) codes assigned by The Centers for Medicare & Medicaid Services (CMS):

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Out-of-State Provider Notification: Contact Your Local Blues Plan for Electronic Remittance Advice (835 ERA) Enrollment

Jun. 10, 2019

Out-of-state providers rendering services to Blue Cross and Blue Shield of Montana (BCBSMT) members should specifically contact their local Blue Cross and Blue Shield (BCBS) Plan for 835 ERA enrollment. If an existing enrollment is already on file with the local BCBS Plan, then ERA files for BCBSMT members will be transmitted electronically to the provider under the Blue Cross Blue Shield Association's BlueCard® program.

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Pharmacy Program Updates: Quarterly Pharmacy Changes

Jun. 07, 2019

Based on the availability of new prescription medications and Prime’s National Pharmacy and Therapeutics Committee’s review of changes in the pharmaceuticals market, some additions, revisions (drugs still covered but moved to a higher out-of-pocket payment level) and/or exclusions (drugs no longer covered) will be made to the Blue Cross and Blue Shield of Montana (BCBSMT) drug lists. Your patient(s) may ask you about therapeutic or lower cost alternatives if their medication is affected by one of these changes. Changes effective July 1, 2019 are outlined below.

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In-Home Colorectal Cancer Screening Test Provided to Select Members

May. 08, 2019

The Centers for Disease Control and Prevention says one-third of adults age 50 or older have not been screened for colorectal cancer as recommended. 1Together, we can help our members at the greatest risk of developing colorectal cancer get the screening they need by making it easier. Some of your patients in Montana who are 51 to 75 years old and have not had a screening, may receive a Fecal Immunochemical Test (FIT) Kit. The FIT Kit is a convenient option for our members to be screened in the comfort and privacy of their homes at no additional charge.

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Check Your Patients’ Behavioral Health Preauthorization Requirements

May. 07, 2019

Beginning July 15, 2019, we are improving our claims review process for behavioral health services that require preauthorization. This will result in more consistent and accurate claims payment.

As a reminder, the following behavioral health services typically need preauthorization:

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Centers for Medicare & Medicaid Services Required Initial Validation Audit (IVA) Begins in June

May. 06, 2019

As an insurer participating in the Affordable Care Act's (ACA) Risk Adjustment (RA) program, Blue Cross and Blue Shield of Montana (BCBSMT) needs your participation in the Centers for Medicare & Medicaid Services (CMS) required Initial Validation Audit (IVA). The IVA will be performed on a random sample of members enrolled in ACA-compliant individual and small group plans, including plans that are available on and off the Exchange. CMS mandates that BCBSMT provide the full 2018 medical records from the physician office and hospital records for those members selected to be audited. 

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Provider Education Webinar: Behavioral Health Telehealth

May. 03, 2019

Learn more about telehealth related to Behavioral Health including what telehealth looks like for Behavioral Health, the various potential for utilization and the possible impact.

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Effective 7/1/2019 Change to Blue Cross and Blue Shield of Montana Clinical Laboratory Fee Schedule

Apr. 30, 2019

Effective 7/1/2019 Blue Cross and Blue Shield of Montana (BCBSMT) Clinical Lab fee schedule will change to 135% of the published 2018 CMS Clinical Lab fee schedule. Previously, laboratory codes were priced at 145% beginning 5/1/2018. This change aligns BCBSMT with standard national laboratory code pricing rates and improves the quality and cost-effective care for our members. The official notice for this change was published in the Clinical Laboratory Compensation Policy on 5/1/2019.

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Requirements for Sleep Studies Effective 1/1/2019

Apr. 30, 2019

The Blue Cross and Blue Shield of Montana (BCBSMT) medical policy, “Diagnosis and Medical Management of Obstructive Sleep Apnea Syndrome” effective 1/1/2019 contains the BCBSMT criteria for coverage of sleep studies. BCBSMT requires preauthorization for in-lab sleep studies. If the clinical criteria for coverage for an in-lab sleep study is not met, an unattended home sleep study may be an option.

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BCBSMT Now Offers a Choice in Pharmacies for Specialty Medications

Apr. 26, 2019

We are happy to let you know that both Accredo and AllianceRx Walgreens Prime are now in-network pharmacies for specialty medications covered under the medical benefit for the 2019 calendar year. Please note: This only applies to specialty medications that are covered under a medical benefit plan and are administered by a provider and does not apply to self-administered drugs covered under a pharmacy benefit. Additionally, certain new-to-market or limited distribution drugs may require an alternative specialty pharmacy. Please call the number on the members’ ID card to verify coverage, or for questions about their benefits.

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Sage Therapeutics Introduces Postpartum Depression Infusion Drug

Apr. 18, 2019

At the 2018 Clinical and Scientific Meeting of the American College of Obstetricians and Gynecologists results for Zulresso (brexanolone IV) were presented in poster sessions.

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Provider Education Webinar: Blue Value Primary Care Model (BVPCM)

Apr. 16, 2019

The Blue Value Primary Care Model, commonly referred to as Patient Centered Medical Home (PCMH), is a voluntary primary care alternative payment model for health care delivery in which the primary care provider is financially compensated through participation and care coordination, chronic disease management, and quality outcomes for Blue Cross Blue Shield attributed members.

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Change in Reject Notification for Invalid National Drug Codes (NDCs) Used on Electronic Medicare Advantage Claims

Apr. 12, 2019

The notice applies to providers submitting electronic claims for the following Blue Cross and Blue Shield of Montana (BCBSMT) members:

  • Blue Cross Medicare Advantage (HMO)SM
  • Blue Cross Medicare Advantage (PPO)SM

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The New Great Depression

Apr. 08, 2019

More than 9 million commercially insured Americans have been diagnosed with depression - a number that has climbed 33 percent since 2013. In fact, 89 percent of Americans adults say that depression is a very serious or somewhat serious condition. However, 2 million of those diagnosed in 2016 did not seek treatment. As a growing number of pharmaceutical and behavioral therapeutic options become available, it’s critical to connect people with the individualized treatment that works for them.

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National Prescription Drug Take Back Day April 27, 2019

Apr. 04, 2019

When you talk to your patients about how to take prescribed medications, do you also ask if they know what to do with unused medications when no longer needed?

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Save Time by Using eviCore Web Portal for Preauthorization Requests

Apr. 02, 2019

Blue Cross and Blue Shield of Montana (BCBSMT) contracts with eviCore healthcare (eviCore), an independent specialty medical benefits management company, for outpatient specialty preauthorizations.

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Making an Impact in Our Community

Apr. 01, 2019

Blue Cross and Blue Shield of Montana has a long history of protecting members and helping them be at their best. And we’re not done.

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Three Character Prefix on Member ID Cards

Mar. 26, 2019

Blue Cross and Blue Shield member identification numbers usually begin with a three-character prefix. Prior to April 2018, the prefixes included letters only. To ensure we have enough prefixes to support our current and future business needs, the Blue Cross and Blue Shield Association has determined that the prefixes may now be alphanumeric.

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Pharmacy Program Updates: Quarterly Pharmacy Changes Effective April 1, 2019

Mar. 14, 2019

Based on the availability of new prescription medications and Prime’s National Pharmacy and Therapeutics Committee’s review of changes in the pharmaceuticals market, some additions, revisions (drugs still covered but moved to a higher out-of-pocket payment level) and/or exclusions (drugs no longer covered) were made to the Blue Cross and Blue Shield of Montana (BCBSMT) drug lists. Your patient(s) may ask you about therapeutic or lower cost alternatives if their medication is affected by one of these changes. Changes that were effective April 1, 2019 are outlined below.

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Behavioral Health Care Providers – Update the information about your practice by March 31, 2019

Mar. 07, 2019

We’re updating our Provider Finder® to help our members find the behavioral health care they need. To make sure we have the most accurate information about what you do, please take the survey that applies to your practice at the link below.

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2019 Fee Schedule and Compensation Policy Update

Mar. 01, 2019

The BCBSMT Medical Service Fee Schedules will be on a biennial update. The next full Medical Service Fee Schedules’ update will occur in 2020. This change from annual to biennial update is to improve predictability and streamline administrative processes for our provider network. Any interim compensation updates will be published on the BCBSMT Secure Provider Portal with a 60-day advance notification to providers.

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BCBSMT’s Payer Spaces Updates in Availity® Provider Portal

Feb. 13, 2019

The Blue Cross and Blue Shield of Montana (BCBSMT)-branded Payer Spaces section in the Availity Portal delivers quick access to payer-specific applications, resources and announcements. You must be a registered Availity user to access Payer Spaces. If you are not yet registered, visit availity.com and select register, then complete the guided registration process - at no cost.

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Government Programs: Verifying Claim Status in the Availity® Provider Portal

Feb. 13, 2019

This notice applies to providers rendering services for the following Blue Cross and Blue Shield of Montana (BCBSMT) government programs members:

  • Blue Cross Medicare Advantage HMOSM
  • Blue Cross Medicare Advantage PPOSM

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Behavioral Health Care Providers: We Need Your Help to Improve Access to Care

Feb. 06, 2019

The need for behavioral health care continues to rise in Montana1. For a variety of reasons, 56 percent of people who need help do not get it2. One reason is because they don’t know where to go for help. Blue Cross and Blue Shield of Montana (BCBSMT) is trying to make it easier for our members to know where to go.

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Pharmacy Program Updates: Quarterly Pharmacy Changes Effective January 1, 2019

Feb. 04, 2019

As we head into 2019 we want to thank our providers for making 2018 a healthier year for so many of our members. We also want to take this time to remind providers of the upcoming changes for 2019.

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Join us for an Online Clinical Data Exchange for Quality and Risk Adjustment Webinar

Jan. 31, 2019

Online Clinical Data Exchange for Quality and Risk Adjustment Webinar

Use the links below to register for sessions covering the Medical Attachments, CQV and CERA tools. Select a session date and time:

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New and Updated Behavioral Health Forms

Jan. 11, 2019

Starting, Jan. 1, 2019, you will notice some changes to Blue Cross and Blue Shield of Montana’s (BCBSMT) behavioral health request forms. The changes will make it easier for you to navigate the forms. The forms also include the new Current Procedural Terminology (CPT®) codes for Applied Behavioral Analysis (ABA).

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Hold Times and Yearly Eligibility Changes

Jan. 08, 2019

If you've called us and were placed on hold, thank you for your patience during this busy time. Please limit calls about yearly eligibility changes to those patients that are scheduled for an appointment.

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New Opioid Drug Management Program for Medicare Members

Jan. 08, 2019

On January 1, 2019, BCBSMT implemented a new opioid drug management program to promote the safe and effective use of prescription opioids for our Medicare Part D members who have prescription drug benefits administered through Prime Therapeutics.

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