2020 News and Updates

View Professional Provider Fee Schedule via Availity® – Coming Soon

Dec. 30, 2020

Fee schedules are a key component of your contractual relationship with Blue Cross and Blue Shield of Montana (BCBSMT). To ensure you have this information quickly, BCBSMT is implementing a new online Fee Schedule viewer tool via the Availity Provider Portal for participating professional providers. Once available, professional providers may use this Availity offering to electronically request a range of up to 20 procedure codes and immediately receive the contracted price allowance for the patient services you perform.

Read More


Pharmacy Program Updates: Quarterly Pharmacy Changes Effective Jan. 1, 2021 – Part 2

Dec. 30, 2020

Read More


New HEDIS® Tip Sheets* Behavioral Health HEDIS Measures: FUA and FUM

Dec. 24, 2020

Behavioral Health HEDIS Measures: FUA and FUM

We’ve added two additional behavioral health tip sheets to help you satisfy Healthcare Effectiveness Data and Information Set (HEDIS) measures and code claims appropriately:

Read More


COVID-19 Vaccines and Coverage

Dec. 18, 2020
Updated Dec. 21, 2020
Updated March 11, 2021

In the face of the COVID-19 pandemic, pharmaceutical companies have moved to produce vaccines. The Food and Drug Administration (FDA) has awarded an Emergency Use Authorization (EUA) to three companies for their vaccines: Pfizer on Dec. 11, 2020, Moderna on Dec. 18, 2020, and Janssen Pharmaceutical Companies of Johnson & Johnson on Feb. 27, 2021

Read More


Obtain BCBSMT Patient ID Numbers Online via Availity® – Now Available for Government Programs

Dec. 15, 2020

In the August News and Updates, we introduced a new online tool via Availity called Patient ID Finder. This tool allows you to quickly obtain a Blue Cross and Blue Shield of Montana (BCBSMT) patient’s insurance ID and group numbers after entering patient-specific data elements

Read More


Hospitals Must Provide Medicare Outpatient Observation Notice (MOON)

Dec. 14, 2020

Hospitals and Critical Access Hospitals (CAH) are required to give the standardized Medicare Outpatient Observation Notice (MOON) to our Blue Cross Medicare AdvantageSM members who are under outpatient observation for more than 24 hours. The notice explains why the members aren't inpatients and what their coverage and cost-sharing obligations will be.

Read More


Patients in the Qualified Medicare Beneficiary (QMB) Program Should Not Be Billed

Dec. 11, 2020

If you participate in Blue Cross Medicare AdvantageSM plans, you may not bill our members enrolled in QMB, a federal Medicare savings program

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

Read More


BCBSMT will update CPT® codes for some outpatient services, added efficiencies with AIM Specialty Health® (AIM)

Dec. 11, 2020

What's New: On March 15, 2021, Blue Cross and Blue Shield of Montana (BCBSMT) will update its list of Current Procedural Terminology (CPT) codes requiring preauthorization, for some commercial members, to reflect new, replaced or removed codes due to a BCBSMT Utilization Management update.

Read More


HMK-CHIP Claims Administration Changes Effective October 1, 2020

Dec. 04, 2020

Effective October 1, 2020 the administration of the HMK-CHIP has changed the claims administration for Durable Medical Equipment, Prosthetics, Orthotics, Medical Supplies Providers (DMEPOS), and Hearing Aid benefits.

Read More


Medicare Adds Benefit for Members with Inherited Ovarian or Breast Cancer

Nov. 25, 2020

The Centers for Medicare & Medicaid Services (CMS) added a benefit this year for Medicare members with germline or inherited ovarian or breast cancer. The benefit covers a laboratory diagnostic test using Next Generation Sequencing (NGS). These tests provide genetic analysis of a patient's cancer.

Read More


More Information: Preauthorization changes for some commercial plan members Effective Jan. 1, 2021

Nov. 25, 2020

What’s changing?

Last month in News and Updates we told you the utilization management vendor that processes preauthorizations for some of our commercial members is changing. Starting Jan. 1, 2021, preauthorization requests for commercial Blue Cross and Blue Shield of Montana (BCBSMT) members that are currently required to be submitted through eviCore healthcare will require preauthorization through AIM Specialty Health® (AIM).

Read More


Bamlanivimab

Nov. 23, 2020

Update: As of April 16, 2021, the U.S. Food and Drug Administration revoked the emergency use authorization for bamlanivimab when used along to treat COVID-19. It is still authorized for use in combination with estesevimab.


Providers receiving bamlanivimab for free should not bill for the product

Blue Cross and Blue Shield of Montana (BCBSMT) continues to provide access to medically necessary care for the treatment of COVID-19. The U.S. Food and Drug Administration granted emergency use authorizaton (EAU) for Eli Lilly and Company's investigational neutralizing antibody bamlanivimab. Bamlanivimab is authorized under the EUA to treat mild to moderate COVID-19 in high-risk patients.

Read More


Revision to Specialty Medication Administration Site of Care Policy, Effective Jan. 1, 2021

Nov. 13, 2020

The Specialty Medication Administration Site of Care Policy, effective March 15, 2020, will be updated to add these HCPCS codes: J0791, Q5121, J0584, J3060, J0223, J0638, J3245, J3397, J0222, J3241, J1746, J1303, J3032 and J1558.

Read More


Verify Multiple Patient’s Eligibility and Benefits Coverage via Availity®

Nov. 12, 2020

Patient eligibility and benefits should be verified before every scheduled appointment. Providers are encouraged to use the Availity Provider Portal or their preferred vendor for eligibility and benefits verification. The Availity Eligibility and Benefits Inquiry offers an Add Multiple Patients feature for providers to check real-time eligibility and coverage details for 2 to 50 patients in the same request. In the Availity Eligibility and Benefits response a Patient Card will appear in the left-side Patient History list, for each patient requested. Patient Cards will be available for interpretation for 24 hours at which time they will auto delete from the Patient History list.

Read More


View, Download and Print the BCBSMT Member’s ID Card Online via the Availity® Provider Portal

Nov. 11, 2020

Blue Cross and Blue Shield of Montana (BCBSMT) is excited to offer providers the ability to view, download and print the member’s medical ID card online via the Availity Eligibility and Benefit Inquiry results (271 transaction). This new and more convenient option will be available for medical ID cards issued to BCBSMT members in Dec. 2020, making it easier to obtain the member’s ID card for your records.

Read More


New Behavioral Health Tip Sheets

Nov. 11, 2020

Two new behavioral health tip sheets have been added to help you provide quality care to our members. The tip sheets include measurement requirements, best practices and billing codes:

Read More


2021 Commercial Preauthorization Code Lists Now Available on the Provider Website

Nov. 06, 2020

We have added 2021 Commercial preauthorization code lists to the provider website. Providers can verify Current Procedural Terminology (CPT) or Healthcare Common Procedure Coding System (HCPCS) code-specific preauthorization requirements for the following:

Read More


BCBSMT Will Update CPT® Codes for Some Preauthorization Services

Nov. 05, 2020

On Jan. 1, 2021, Blue Cross and Blue Shield of Montana (BCBSMT) will update its list of Current Procedural Terminology (CPT) codes to comply with changes due to a BCBSMT system update and updates from the American Medical Association (AMA). These changes are the result of new, replaced or removed codes implemented by BCBSMT and the AMA.

Read More


Updates and Reminders: Submit Predetermination of Benefits Submission via Availity®

Nov. 05, 2020

On July 30, 2020, Blue Cross and Blue Shield of Montana (BCBSMT) implemented an electronic predetermination of benefits submission process via Availity’s Attachments tool. Updates were recently made to the Attachments tool to better assist you with submitting your requests online to BCBSMT.

Read More


Billing Reminders for Psychological and Neuropsychological Testing

Nov. 04, 2020

Below are billing reminders for psychological and neuropsychological testing. Proper coding of the specific services provided can help expedite claim processing and support accurate claim payment. Blue Cross and Blue Shield of Montana (BCBSMT) may reach out to you by phone or email when we note incorrect coding patterns.

The following are common Current Procedural Terminology (CPT®) codes for billing psychological and neuropsychological testing services:

Read More


No-Charge Webinar and Continuing Education Credit for Providers, Wednesday, Nov. 11

Nov. 03, 2020

Below is a list of resources to help you involve your patients in shared decision-making. The evidence-based aids provide information about treatment options, lifestyle changes and outcomes. They don't replace your guidance but can help your conversations with your patients. The list is also on our website.

Read More


Preauthorization Requirements Changing for BCBSMT Medicare Advantage Members

Oct. 29, 2020

Effective Jan. 1, 2021, for some MA plan members

What's changing?

Effective Jan. 1, 2021 preauthorization will no longer be required for musculoskeletal services, listed by codes under spine surgery and large joint services, for some Blue Cross and Blue Shield of Montana Medicare Advantage members. 

Read More


Are you using these shared decision-making aids?

Oct. 29, 2020

Below is a list of resources to help you involve your patients in shared decision-making. The evidence-based aids provide information about treatment options, lifestyle changes and outcomes. They don't replace your guidance but can help your conversations with your patients. The list is also on our website.

Read More


Pharmacy Program Updates: Quarterly Pharmacy Changes Effective Jan. 1, 2021 – Part 1

Oct. 28, 2020

Read More


BCBSMT Preauthorization Duties Changing from eviCore to AIM

Oct. 28, 2020

Effective Jan. 1, 2021, for some commercial plan members

What’s changing?
The utilization management vendor that processes preauthorizations for some of our commercial members is changing. Starting Jan. 1, 2021, preauthorization requests for commercial Blue Cross and Blue Shield of Montana (BCBSMT) members that are currently required to be submitted through eviCore healthcare will require preauthorization through AIM Specialty Health® (AIM).

Read More


Now Available for All BCBSMT Members: Availity Claim Status Tool

Oct. 14, 2020

In Nov. 2019, Blue Cross and Blue Shield of Montana (BCBSMT) launched the Availity Claim Status tool for providers to verify detailed claim status online for Medicare Advantage members. Starting Oct. 19, 2020, this tool will include detailed claim status for commercial, Federal Employee Program® (FEP®) and on and off exchange members. This improvement will increase your administrative efficiencies by offering you a single tool to check claim status online for all your BCBSMT patients.

Read More


Submit Electronic Professional and Facility Claims via the Availity® Provider Portal

Oct. 13, 2020

The Availity Provider Portal offers providers a no cost solution to submit electronic Professional and Institutional claims (ANSI 837P and 837I transactions) to Blue Cross and Blue Shield of Montana (BCBSMT). Electronic claim submission can accelerate the claim and reimbursement process.

Read More


Availity® Provider Portal Offerings

Oct. 13, 2020

The Availity provider engagement portal helps providers and Blue Cross and Blue Shield of Montana (BCBSMT) to securely share information easily and efficiently. Using Availity allows you to quickly verify patient eligibility and benefits, confirm prior authorization requirements, submit prior authorization requests, check claim status, obtain provider claim summaries, and more without having to call BCBSMT.

Read More


Itemized Bills Required for BlueCard® Facility Claims Over $100k

Sep. 30, 2020

Beginning Jan. 1, 2021, we will require facilities to submit an itemized bill for inpatient care billed for $100,000 or more. This applies to all facility claims for $100,000 or more submitted for BlueCard out-of-area Blue Cross and Blue Shield members. An itemized bill helps ensure an accurate claim payment and reduces the need to submit more information after a claim is paid.

Read More


Telemedicine Post COVID-19 Accommodations

Sep. 30, 2020

Telemedicine – Future State

Post-COVID-19 Accommodations

In response to the COVID-19 pandemic, Blue Cross and Blue Shield of Montana (BCBSMT) expanded access to telemedicine services to give our members greater access to care. Moving into 2021 as the COVID-19 accommodations expire, telemedicine will continue to be a standard offering for our members. Members will be able to access their medically necessary, covered benefits through providers who deliver services through telemedicine.

Read More


Verify Procedure Code Preauthorization Requirements and Submit the Request via Availity®

Sep. 29, 2020

Providers can electronically verify Current Procedural Terminology (CPT) or Healthcare Common Procedure Coding System (HCPCS) code-specific preauthorization requirements and submit preauthorization requests handled by Blue Cross and Blue Shield of Montana (BCBSMT) all within the Availity Provider Portal.

Read More


Clinical Practice and Preventive Care Guidelines Updated for 2020-2021

Sep. 24, 2020

Our medical directors and Quality Improvement Committee have updated our Clinical Practice Guidelines and Preventive Care Guidelines PDF Document for 2020-2021. The guidelines are built on evidence-based standards of care and nationally recognized medical authorities to direct our quality and health management programs and improve member care. They can help guide your decision-making as you care for our members.

Read More


Updated THM Form Measures to Align with U.S. Preventive Services Taskforce Guidelines

Sep. 23, 2020

Our Blue ValueSM Total Health Management (THM) program is based on member/patient engagement, establishing a relationship with a Primary Care Provider (PCP), and completing a preventive care exam and recommended screenings.

Read More


New National High-Performance Network to Launch in January

Sep. 23, 2020

In January 2021, the Blue Cross and Blue Shield System is launching Blue High Performance NetworkSM (Blue HPNSM), a new national network for large commercial employer groups. While Blue Cross and Blue Shield of Montana (BCBSMT) doesn’t currently offer this network, providers in our networks may provide urgent and emergent care to Blue HPN members from other BCBS Plans.

Read More


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

Sep. 22, 2020

Read More


Childhood Immunization Rates Fall Amidst Pandemic Fears

Sep. 18, 2020

The Problem
After the pandemic declaration in March, office visits for immunizations among Blue Cross and Blue Shield of Montana (BCBSMT) members significantly dropped between March and May compared with the number of visits reported during the same period in 2019.

Read More


Complimentary Substance Abuse Webinar and Continuing Education Credit for Providers

Sep. 11, 2020

What You Need to Know About Substance Abuse

Complimentary Webinar and Continuing Education Credit for Providers


Join one of our board-certified psychiatrists and behavioral health medical directors for a one-hour webinar on substance abuse called What You Need to Know About Substance Abuse. The webinar is on Wednesday, Sept. 30, 2020, at noon (MDT).
It is no-charge to all providers. Those who attend will earn one continuing medical education credit or continuing education unit.

Read More


BCBSMT Extends Telemedicine Benefits and Cost-Share Through Dec. 31, 2020

Sep. 11, 2020

We have extended coverage to clinically appropriate medical and behavioral health services delivered through in-network telemedicine providers through Dec. 31, 2020.

Read More


Share Your Medication Assisted Treatment Designation

Sep. 03, 2020

Use Our Demographic Change Form

If you offer opioid addiction or withdrawal treatment, consider making this information available to our members and other providers in our Provider Finder®. This will help others identify you when referring their patients for medication assisted treatment (MAT) care and services.

Read More


Overpayment Recovery Process for Contracted Providers

Sep. 01, 2020

Changes as of Jan. 1, 2020

Blue Cross and Blue Shield of Montana (BCBSMT) payment processes were updated on Jan. 1, 2020. You may have noticed changes in the number of payments you receive from us and in our overpayment recovery process.

Read More


Obtain BCBSMT Patient ID Number Numbers Online via Availity®

Aug. 31, 2020

To help you obtain a Blue Cross and Blue Shield of Montana (BCBSMT) patient insurance ID number, we recently implemented a new online tool called Patient ID Finder located in our BCBSMT-branded Payer Spaces section via the Availity Provider Portal.

Read More


In-Home Test Kits for Diabetics

Aug. 28, 2020

Monitor Diabetes Control

Blue Cross and Blue Shield of Montana (BCBSMT) is working with Home Access Health Corporation to provide in-home test kits for some of our fully insured individual members with diabetes. Because of the COVID-19 pandemic, many have delayed getting appropriate care. Home Access Health Corporation is sending out two different kits to members who have not received the recommended testing to close care gaps: hemoglobin A1c test kits and microalbumin urine test kits.

Read More


Blue Distinction® Message via the Availity® Eligibility and Benefits Results

Aug. 28, 2020

Starting Sept. 1, 2020, the Availity Eligibility and Benefits Inquiry results will include informational Blue Distinction® Center (BDC) messaging for the below specialty care categories when the patient’s policy has a Blue Distinction component. The Availity benefit response will include applicable coverage for the service selected. However, if you need to confirm the specific BDC benefit differential, you will need to call the Customer Service phone number found on the back of the member’s Blue Cross and Blue Shield of Montana (BCBSMT) identification card.

Read More


Telehealth Visits ̶ Medicare Advantage

Aug. 27, 2020
Updated Sept. 09, 2020

Telehealth can help provide our members access to the care they need, including routine care, while helping to protect against the spread of viruses. Due to the COVID-19 Public Health Emergency, Blue Cross and Blue Shield of Montana (BCBSMT) has expanded access to telehealth at no cost-share* for our Medicare Advantage members through Dec. 31, 2020. See our FAQs for Medicare Providers PDF Document for more information.

Read More


BCBSMT Extends Telemedicine Benefits Through Dec. 31, 2020

Aug. 10, 2020

Blue Cross and Blue Shield of Montana (BCBSMT) has extended coverage to clinically appropriate medical and behavioral health services delivered through in-network telemedicine providers through Dec. 31, 2020. We are waiving copays or deductibles through Sept. 30, 2020 (previously Aug. 31, 2020). This will make it easier for members to access care while reducing their risk of exposure.

Read More


Behavioral Health Measures from HEDIS® 2020-21*

Aug. 06, 2020

We’ve created two new behavioral health tip sheets to help you satisfy Healthcare Effectiveness Data and Information Set (HEDIS) measures and code appropriately. These measures from the National Committee for Quality Assurance (NCQA) help ensure our members receive appropriate care.

Read More


Imaging Studies for Low Back Pain

Aug. 04, 2020

Federal Employee Program (FEP) Members

The preferred conservative medical treatment for uncomplicated low back pain (LBP) is prescription-strength analgesics and physical therapy. Evidence does not support routine imaging for uncomplicated LBP. Severe LBP improves for most individuals within the first two weeks of onset. Imaging when not indicated may expose members  to unnecessary radiation and expense.1

Read More


iExchange® Will Be Deactivated on Aug. 17, 2020

Jul. 31, 2020

Our current electronic preauthorization and predetermination of benefits request tool, iExchange, will be deactivated on August 17, 2020.

Read More


Behavioral Health Webinar and Continuing Education Credit at no charge for Providers

Jul. 30, 2020

Join one of our board-certified psychiatrists and behavioral health medical directors for a one-hour webinar on depression called Depression? How do you know? The webinar is on Friday, Aug. 14, 2020, at noon (MST).

Read More


Avoid National Drug Code (NDC) Billing Mistakes

Jul. 29, 2020

Submitting claims with the appropriate NDC information may help with claims processing and may help you spend less time troubleshooting a rejected claim line.

Read More


Submit Predetermination of Benefits Requests via the Availity®

Jul. 27, 2020

Blue Cross and Blue Shield of Montana (BCBSMT) is excited to introduce an electronic predetermination process via the Availity Portal using the Attachments tool. This new process is available to providers as of July 30, 2020, making it faster and easier to submit a predetermination request to BCBSMT.

Read More


Healthy Montana Kids Providers Deadline Extended to Aug. 3, 2020 for Provider Relief Fund

Jul. 23, 2020

Great news from Montana Department of Public Health and Human Services (DPHHS): The U.S. Department of Health and Human Services (HHS) has extended the deadline to apply for payment from the Provider Relief Fund General Allocation to August 3, 2020.

Read More


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

Jul. 15, 2020

Read More


Colorectal Cancer Screening at Home

Jul. 10, 2020

Consider screening our members who are 50 to 75 years old for colorectal cancer. Members in our Blue Preferred PPOSM and Blue Focus POSSM networks who have not been screened may qualify for a Fecal Immunochemical Test (FIT) Kit at no extra charge. We are working with Home Access Health Corporation to provide in-home kits to encourage screening for our at-risk members. Screening with a FIT Kit may be a good option to close care gaps.

Read More


Important COVID-19 Initiative Dates Extended to August 31, 2020

Jul. 03, 2020

BCBSMT has extended end dates to August 31, 2020 for the following COVID-19 initiatives:

  • COVID-19 Treatment Cost-Share Waiver
  • Telemedicine Expansion, Cost-Share Waiver (Medicare end date is 12/31/2020)

Read More


Update: End Date Extended BCBSMT Waives Customer Cost-Sharing For COVID-19 Treatment

Jul. 02, 2020

Blue Cross and Blue Shield of Montana (BCBSMT) is waiving member cost-sharing, including deductibles, copayments and coinsurance related to treatment for COVID-19. The waiver applies to costs associated with COVID-19 treatment at in-network facilities and treatment for out-of-network emergencies.

Read More


New Clinical Payment and Coding Compensation Policy for Non-Reimbursable Experimental, Investigational and/or Unproven Service (EIU), Effective 9/1/2020

Jul. 02, 2020

Blue Cross and Blue Shield of Montana (BCBSMT) has updated Clinical Payment and Coding Policies to include a new Non-Reimbursable Experimental/Investigational/Unproven Services Policy, effective September 1, 2020. 

Read More


Healthy Montana Kids Durable Medical Equipment Reimbursement Change Effective June 20, 2020

Jun. 25, 2020

Effective June 20, 2020 Healthy Montana Kids (HMK) will reimburse covered, medically necessary Durable Medical Equipment (DME) at 100% of the DME BCBSMT fee schedule located on the BCBSMT Secure Provider Portal.

Read More


Federal Agencies Extend Timely Filing and Appeals Deadlines

Jun. 20, 2020

As a result of the National Emergency declared on March 1, 2020, the Employee Benefits Security Administration, Department of Labor, Internal Revenue Service and the Department of the Treasury extended certain timeframes to ease the burden of maintaining benefits and compliance with notice obligations. Blue Cross and Blue Shield of Montana (BCBSMT) will follow these guidelines .

Read More


Read More


BCBSMT to Launch Epic’s Platform to Improve Provider Experience

Jun. 18, 2020

New technology will enhance exchange of health data to empower patients and providers, improve quality of care and lower health care costs.


Read More


Credentialing Process Simplified For COVID-19

Jun. 05, 2020

Blue Cross and Blue Shield of Montana is temporarily updating our credentialing policy and processes in response to the COVID-19 emergency. This complies with emergency state and federal regulations and is effective April 3, 2020. The temporary modifications are only in place during the COVID-19 emergency and subject to change based upon state and federal action. Otherwise, standard credentialing processes will apply.

Read More


Medicare Advantage CPT® Codes Update for Some Prior Authorization Services

Jun. 05, 2020

On Sept. 1, 2020, Blue Cross and Blue Shield of Montana (BCBSMT) will update the Medicare Advantage list of Current Procedural Terminology (CPT) codes to comply with changes from the American Medical Association (AMA). These changes are the result of new, replaced or removed codes implemented by the AMA.

Read More


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

Jun. 04, 2020

Read More


Remember to Use In-Network Laboratories

May. 28, 2020

Blue Cross and Blue Shield of Montana (BCBSMT) reminds and recommends its network of health care providers to refer our members, your patients, to participating, in-network providers.

Read More


COVID-19 Initiatives Important Dates

May. 20, 2020
Updated June 22, 2020
Updated July 2, 2020
Updated Aug. 10, 2020
Updated Sept. 10, 2020
Updated Oct. 09, 2020
Update Jan. 1, 2021

Blue Cross and Blue Shield of Montana (BCBSMT) has taken steps to make access to the testing and treatment for our members easier and less expensive during this national health emergency. We have extended the duration of these measures to continue serving our members.

The chart below details those dates. We will continue to monitor the situation and update as needed. Check our provider site and News & Updates for the latest information on each initiative.

Read More


COVID-19 Initiatives Extended into June

May. 20, 2020

Blue Cross and Blue Shield of Montana (BCBSMT) has taken steps to make access to the testing and treatment for our members easier and less expensive during this national health emergency. We have extended the duration of these measures to continue serving our members.

The chart below details those dates. We will continue to monitor the situation and update as needed. Check our provider site and News & Updates for the latest information on each initiative.

Read More


EviCore Online Trainings in June

May. 19, 2020

Learn how to Submit a Prior Authorization through the eviCore Web Portal

The eviCore healthcare (eviCore) web portal is the best way to request a prior authorization and to check the status of an existing request.

New or experienced users can get tips on using the eviCore portal by attending one of the sessions below. Registration is required, the training is free and lasts about one hour.

Read More


Extending Prior Authorization on Previously-Approved Elective Surgeries, Procedures and Therapies

May. 19, 2020

Blue Cross and Blue Shield of Montana (BCBSMT) is temporarily extending approvals on services with existing prior authorizations until Dec. 31, 2020. This applies to services that were originally approved or scheduled between Jan. 1 and June 30, 2020 (previously April 1, 2020). This is for most non-emergent, elective surgeries, procedures, therapies, home visits and behavioral health services.

A member may reschedule an approved procedure to a later date in 2020 without a new prior authorization. This applies only to active members for a benefit that is covered under their plan at the time services are rendered.

We will continue to monitor the national health emergency and will update as appropriate.

Read More


Provider Information on COVID-19 Coverage

May. 18, 2020
Updated Feb.11, 2021

Blue Cross and Blue Shield of MT (BCBSMT) is closely monitoring activity around the Novel Coronavirus 2019 (COVID-19). We’ve taken steps to lower costs and provide our members easier access to care related to COVID-19.

Read More


Update: BCBSMT Extends Telemedicine Benefits Through June 30, 2020

May. 18, 2020

Blue Cross and Blue Shield of Montana (BCBSMT) has extended coverage to clinically appropriate medical and behavioral health services delivered through in-network telemedicine providers with no copays or deductibles through June 30, 2020 (previously May 31, 2020). This will make it easier for members to access care while reducing their risk of exposure.

Read More


Update: BCBSMT to Extend Waiving of Customer Cost-Sharing for COVID-19 Treatment to June 30, 2020

May. 18, 2020

Blue Cross and Blue Shield of Montana (BCBSMT) is waiving member cost-sharing, including deductibles, copayments and coinsurance related to treatment for COVID-19. The waiver applies to costs associated with COVID-19 treatment at in-network facilities and treatment for out-of-network emergencies.

Read More


Calls to Electronic Commerce Services will be Redirect to Email as of June 15, 2020

May. 13, 2020

The Blue Cross and Blue Shield of Montana (BCBSMT) Electronic Commerce Services phone number of 800-746-4614 will be retired on June 15, 2020. As of this date providers and/or clearinghouses will be directed to email their inquiries to Electronic Commerce Services instead of calling.

Read More


Update: Change in Advance Member Notification Process July 15, 2020

May. 12, 2020

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) has updated our Advance Member Notification (AMN) process.

Read More


BlueCard® Alert: Prior Authorization Process for California Blue Plan Members with Prefix PHU

May. 09, 2020

Some Blue Shield of California members have coverage from their employer, Prime Healthcare, a California-based health system with facilities in 14 states. You can identify these members by the Prime Healthcare logo and the three-character prefix PHU on their Blue Shield of California ID card.

Read More


Important Reminder Regarding Billing for Point-of-Use Convenience Kits

May. 04, 2020

Blue Cross and Blue Shield of Montana (BCBSMT) regularly reviews claims submitted by providers to help ensure that benefits provided are for services that are included in our member’s benefit plan and meet BCBSMT’s guidelines. Some providers are submitting claims for point-of-use convenience kits used in the administration of injectable medicines. These prepackaged kits contain not only the injectable medicine, but also supply items, such as, but not limited to, alcohol prep pads, cotton balls, band aids, disposable sterile medical gloves, povidone-iodine swabs, adhesive bandages and gauze. As a reminder, only the drug component(s) of the kit will be reimbursable to the provider.

Read More


Medicare Advantage Recoupment Threshold to Be Implemented, Effective August 15, 2020

May. 01, 2020

Beginning August 15, 2020 Blue Cross and Blue Shield of Montana (BCBSMT) Medicare Advantage programs will implement a recoupment letter threshold. Under this new process BCBSMT will no longer request repayment of or initiate recoupment efforts for overpayments of less than $5.00. After implementation no recoupment letters will be mailed, and no balances will be recouped when the original overpayment is less than $5.00.

Read More


Healthy Montana Kids Temporary State of Emergency Preauthorization Changes

Apr. 30, 2020

Effective April 23, 2020, Healthy Montana Kids (HMK), Children's Health Insurance Plan is waiving preauthorization (PA) requirements, with the below exceptions:

Read More


Correction: BCBSMT Extends Modification On Transfer To Post-Acute Care

Apr. 28, 2020

Correction: In the communication on April 23, 2020 we indicated the date of June 15, 2020 as the end date, upon further review the corrected end date is May 15, 2020. Please review the amended communication below.

Blue Cross and Blue Shield of Montana (BCBSMT) is making it easier to transfer our members from acute-care facilities to in-network, medically necessary alternative post-acute facilities until May 15, 2020 (previously April 30, 2020).
We will no longer require a post-acute care facility to wait for prior authorization to transfer our members from an inpatient hospital to an in-network medically appropriate, post-acute site of care such as long-term acute care hospitals, skilled nursing facilities, rehabilitation facilities and in-patient hospice. The receiving facility must call and inform us of the transfer by the next business day.

Read More


Easier Access Chest CT Scans Extended

Apr. 27, 2020

With the rapidly evolving COVID-19 public health crisis, Blue Cross and Blue Shield of Montana has extended temporarily simplifying access to chest computed tomography (CT) (original deadline was April 30, 2020). This will allow our members to get access to the care they need for the duration of the public health emergency.

Read More


BCBSMT Extends Telemedicine Benefits Through May 31, 2020

Apr. 20, 2020

Blue Cross and Blue Shield of Montana (BCBSMT) has extended coverage to clinically appropriate medical and behavioral health services delivered through in-network telemedicine providers with no copays or deductibles through May 31, 2020. This will make it easier for members to access care while reducing their risk of exposure.

Read More


BCBSMT Extends Telemedicine Benefits Through July 31, 2020

Apr. 20, 2020
Updated June 22, 2020

Blue Cross and Blue Shield of Montana (BCBSMT) has extended coverage to clinically appropriate medical and behavioral health services delivered through in-network telemedicine providers with no copays or deductibles through July 31, 2020 (previously May 31, 2020). This will make it easier for members to access care while reducing their risk of exposure.

Read More


BCBSMT Modifies Telemedicine Coverage and Cost Sharing in Response to COVID-19

Apr. 17, 2020

Updated May 18, 2020

Updated July 2, 2020

Updated Aug 10, 2020

Updated Sept 10, 2020

Blue Cross and Blue Shield of Montana (BCBSMT) is responding to the coronavirus (COVID-19) and expanding our coverage for medically necessary, covered medical and behavioral health telemedicine visits to include phone calls between providers and patients through Dec. 31, 2020. We are also giving our members access to clinically appropriate medical and behavioral health services delivered through in-network telemedicine providers with no copays or deductibles through Dec. 31, 2020 (previously Sept. 30, 2020). This will make it easier for members to access care while reducing their risk of exposure.

The cost-share waiver applies to all fully insured members whose benefit plan includes telemedicine. It applies to claims with dates of service February 4, 2020, through Dec. 31, 2020 (previously Sept. 30, 2020).

Read More


Making It Easier to Access CT Chest Scans

Apr. 17, 2020

With the rapidly evolving COVID-19 public health crisis, Blue Cross and Blue Shield of Montana is temporarily simplifying access to chest computed tomography (CT). This will allow our members to get access to the care they need for the duration of the public health emergency.

Read More


Pharmacy Program Updates: Quarterly Pharmacy Changes Effective on or after July 1, 2020 – Part 1

Apr. 16, 2020

Read More


Alert: iExchange® Deactivation Extended Due to COVID-19

Apr. 14, 2020

In response to COVID-19 the iExchange deactivation planned for April 15, 2020, has been temporarily suspended to offer you an extension to convert to the Availity® Authorizations tool during this pandemic.

Given the iExchange extension is only temporary, you are still encouraged to transition and use the Availity Authorizations tool for electronic preauthorization submissions for inpatient admissions and select outpatient services handled by Blue Cross and Blue Shield of Montana (BCBSMT).

Read More


Credentialing Process Simplified for COVID-19

Apr. 09, 2020

Blue Cross and Blue Shield of Montana is temporarily updating our credentialing policy and processes in response to the COVID-19 emergency. This complies with emergency state and federal regulations and is effective April 3, 2020. The temporary modifications are only in place during the COVID-19 emergency and subject to change based upon state and federal action. Otherwise, standard credentialing and processes will apply.

Read More


BCBSMT Making It Easier to Transfer Members to Post-Acute Care

Apr. 07, 2020
Updated Jan. 05, 2021
Updated March 11, 2021

Note: This accommodation expired on Feb. 28, 2021.


Blue Cross and Blue Shield of Montana (BCBSMT) is making it easier to transfer our members from acute-care facilities to in-network, medically necessary alternative post-acute facilities until Feb. 28, 2021.

Read More


BCBSMT Waives Customer Cost-Sharing for COVID-19 Treatment

Apr. 07, 2020
Updated Aug. 10, 2020
Updated Oct. 9, 2020

Blue Cross and Blue Shield of Montana (BCBSMT) is waiving member cost-sharing, including deductibles, copayments and coinsurance related to treatment for COVID-19. The waiver applies to costs associated with COVID-19 treatment at in-network facilities and treatment for out-of-network emergencies.

Read More


Extending Prior Authorization on Previously-Approved Elective Surgeries, Procedures, and Therapies

Apr. 07, 2020

Blue Cross and Blue Shield of Montana (BCBSMT) is temporarily extending approvals on services with existing prior authorizations until Dec. 31, 2020. This applies to services that were originally approved or scheduled between Jan. 1 and April 1, 2020. This is for most non-emergent, elective surgeries, procedures, therapies and home visits.

Read More


COVID-19 Exception Request for Provider Claim Summary (PCS) Mailing Discontinuation on May 4, 2020

Apr. 06, 2020

In the February 2020 News and Updates we announced that on May 4, 2020, Blue Cross and Blue Shield of Montana (BCBSMT) will discontinue the mailing process for paper PCS receivers. * In response to the COVID-19 pandemic, providers may request a temporary exception to continue receiving PCS reports via mail. As an alternative, providers can retrieve PCS report online now using the Reporting On-Demand tool via the Availity® Provider Portal, at no cost.

Read More


COVID-19 Healthy Montana Kids Telemedicine-Telehealth and Cost-Share Changes

Apr. 02, 2020

Effective immediately and until further notice, the Montana Department of Public Health and Human Services (DPHHS) instructed Blue Cross and Blue of Shield of Montana (BCBSMT) to adopt the recent Medicaid coverage and reimbursement policy for Telemedicine/Telehealth services and suspension of cost-share requirements for Healthy Montana Kids (HMK) members during Montana’s COVID-19 state of emergency.

Read More


Reminder: iExchange® Deactivating on April 15, 2020 – Use the Availity® Authorizations Tool

Apr. 01, 2020

Our current electronic preauthorization submission tool, iExchange, will be deactivated on April 15, 2020. As of this date, all electronic preauthorization requests handled by Blue Cross and Blue Shield of Montana (BCBSMT) should be submitted using the Availity Authorizations tool. This includes preauthorization requests for inpatient admissions and select outpatient services handled by BCBSMT.

Read More


BCBSMT COVID-19 & Telemedicine Questions & Answers

Apr. 01, 2020

This page will be updated as needed. Check back for up-to-date information.
Current Update: Dec. 23, 2020

We are continuing to evaluate the evolving state and federal legislative and regulatory landscape relating to COVID-19 and will continue to update our practices accordingly.

What coverage and member share are there for telemedicine visits?
Blue Cross and Blue Shield of Montana (BCBSMT) is responding to the coronavirus (COVID-19) and expanding our coverage for medically necessary, covered medical and behavioral health telemedicine visits to include phone calls between providers and patients through Dec. 31, 2020. We are also giving our members access to medically necessary medical and behavioral health services delivered through in-network telemedicine providers with no copays, coinsurance or deductibles through Dec. 31, 2020. This will make it easier for members to access care while reducing their risk of exposure. The cost-share waiver applies to all fully insured members whose benefit plan includes telemedicine. It applies to claims with dates of service Feb. 4, 2020, through Dec. 31, 2020.

Note: Many of our members are covered under a health plan that is self-insured by their employer. Some of these members may be responsible for copay, coinsurance or deductibles and may have different telemedicine benefits based on their employer’s election to participate in this benefit.

Read More


Compensation Policy Update Effective June 1, 2020

Mar. 30, 2020

Blue Cross and Blue Shield of Montana (BCBSMT) Compensation Policies and Fee Schedules are published on the BCBSMT Secure Provider Portal . The following compensation policies will be published April 1, 2020 and effective June 1, 2020:

Read More


Medicare Advantage Provider Call Center Lines Experiencing Longer Hold Times

Mar. 27, 2020

You may experience longer than normal hold times on our Medicare Advantage Provider call lines 1-877-774-8592 starting March 24, 2020, due to the COVID-19 pandemic.

Read More


Provider Education Webinar – 2020 Pricing Update

Mar. 24, 2020

Please join Simone Wilkinson, system modeling and pricing manager of Blue Cross and Blue Shield of Montana (BCBSMT), 11 AM, Tuesday, May 5 or 2 PM, Thursday, May 7, for an online educational hour on BCBSMT’s 2020 pricing updates.

Read More


COVID-19 Lab Testing Reimbursement Rates

Mar. 19, 2020

As a provider serving Blue Cross and Blue Shield of Montana (BCBSMT) members, we appreciate your efforts to implement protocols to address the urgent COVID-19 situation. BCBSMT recognizes the importance of taking steps to identify and mitigate the spread of this virus.

Read More


Clarification: New BCBSMT 837 Commercial Claim Validation Edits Effective April 1, 2020

Mar. 17, 2020

This is a follow-up to provide clarification on a previous notice, posted Feb. 7, 2020.

Read More


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

Mar. 17, 2020

Read More


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

Mar. 12, 2020

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) has updated our Advance Member Notification (AMN) process. These changes will apply to all lines of BCBSMT business except for Medicare Supplement, Medicare Advantage, and Federal Employee Program effective 1/1/2020.

Read More


Reminder on Predetermination for Dental Accident Claims Applied to Medical Benefits

Mar. 02, 2020

Blue Cross and Blue Shield of Montana (BCBSMT) recommends a predetermination* request be submitted for treatment for members that have dental injuries sustained in an accident. Minor accidents, such as a chipped tooth, do not need a predetermination or treatment plan submitted (records should accompany the claim). A predetermination request will help in the timely and accurate processing of claims for approved treatment.

Read More


Three New ClaimsXtenTM Rules to be Implemented June 2020

Feb. 28, 2020

On or after June 15, 2020, we will update the ClaimsXten software database to better align coding with the reimbursement of claim submissions.

Read More


New Authorizations Tool via Availity® Provider Portal: Revised Launch Date of Feb. 17, 2020

Feb. 27, 2020

This is a follow-up to a previous notice regarding delayed implementation of the new Availity Authorizations tool, which was originally scheduled to launch in late January 2020.

Read More


Obtain Your Provider Claim Summary (PCS) Online – PCS Mailing Discontinuation as of May 4, 2020

Feb. 26, 2020

Are you tired of waiting on your paper mailed provider claim summary (PCS) reports to determine the outcome of claims processed by Blue Cross and Blue Shield of Montana (BCBSMT)? No need to wait, you can obtain your PCS online using the Reporting On-Demand tool via the Availity® Provider Portal. Online self-service access to the PCS allows you to acquire claim processing details in just a few clicks.

Read More


Resolved: Electronic Payment and Remittance Delivery Delay

Feb. 18, 2020

This is a follow-up to a previous notice regarding the delay in receiving Electronic Funds Transfer (EFT) and delivery of Electronic Remittance Advice (835 ERA) and Electronic Payment Summary (EPS) files from Blue Cross and Blue Shield of Montana (BCBSMT).*

Read More


Electronic Payment and Remittance Delivery Delay

Feb. 14, 2020

We’ve identified a system issue that’s affecting electronic payment and remittance transactions for some electronic professional and institutional claims that were processed by Blue Cross and Blue Shield of Montana (BCBSMT) on Feb. 12, 2020 and Feb. 13, 2020.*

Read More


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

Feb. 12, 2020

Read More


New BCBSMT 837 Commercial Claim Validation Edits, Effective April 1, 2020

Feb. 07, 2020

As of April 1, 2020, Blue Cross and Blue Shield of Montana (BCBSMT) will implement new electronic claim submission validation edits for commercial Professional and Institutional claims (837P and 837I transactions).* These claim edits will be applied to claims during the pre-adjudication process to help increase efficiencies and to comply with Medicare data reporting requirements.

Read More


Primary Care Provider and Member Relationships Get Boost Through Blue ValueSM Total Health Management

Feb. 03, 2020

Blue Cross and Blue Shield of Montana (BCBSMT) Blue ValueSM Total Health Management (THM) program is based on member/patient engagement, establishing relationship with a Primary Care Provider (PCP), and completing preventive care exam and screenings.

A combination of your dedicated efforts and the THM program has improved the health of our groups and members. The THM program data speaks for itself, but these numbers don’t show the immeasurable improvement to people’s lives and productivity of the work force.

Read More


Understanding the 2019 Novel Coronavirus

Jan. 31, 2020

The outbreak of the 2019 Novel Coronavirus (2019-nCoV) in China has now appeared in the US, with confirmed cases in Washington state and Chicago, and possible cases at Texas A&M University.

CDC says: The Centers for Disease Control (CDC) consider the health risk low for the American public at this time. The center also reports that human coronaviruses are common throughout the world.

Read More


Implementation Delay: Authorizations via Availity® Provider Portal

Jan. 30, 2020

A December 2019 News and Updates announcement indicated the launch of a new Authorization application via Availity was to occur on Jan. 30, 2020. Additional time is required to ensure this solution is effective in your office workflow. Watch for future News and Updates announcements regarding the upcoming implementation of this new functionality.

For training and education needs, you may contact the Provider Education Consultants.

Read More


Imaging Studies for Low Back Pain

Jan. 21, 2020

The National Committee for Quality Assurance (NCQA) collects Healthcare Effectiveness Data and Information Set (HEDIS®) measurements. The data helps us ensure our members receive appropriate care. One of these measures evaluates the appropriate use of imaging studies for uncomplicated low back pain. Low back pain is a common medical problem. Evidence does not support that routine imaging improves outcomes. It may expose members to unnecessary radiation and expense.1

Read More


Prior Authorization Changes for ID Prefixes BBE, BHP, BNK, BRG and BYR

Jan. 20, 2020

Effective March 1, 2020, some Blue Cross and Blue Shield of Illinois (BCBSIL) members in Montana will have new prior authorization requirements through eviCore healthcare (eviCore). The members have the following ID prefixes:

  • BBE
  • BHP
  • BNK
  • BRG
  • BYR

Read More


Reminder of Change to the Preservice Appeals Process for Medicare Patients

Jan. 15, 2020

This is a reminder that important changes to the preservice appeals process recently occurred for Blue Cross and Blue Shield of Montana (BCBSMT) patients enrolled in Medicare programs, as previously communicated on July 19, 2019.

Read More


Full Medical Service Fee Schedule Update Effective June 1, 2020

Jan. 14, 2020

The Blue Cross and Blue Shield of Montana (BCBSMT) medical service fee schedules are on a biennial update. The next full medical service fee schedules' update will be effective June 1, 2020 for all reimbursement schedules, excluding Infusion Therapy codes, which will be updated by September 1, 2020.

Read More


Two New ClaimsXten™ Rules to be Implemented in 2020

Jan. 10, 2020

We will soon update our ClaimsXten software database to better align coding with the reimbursement of claim submissions.

Read More


Five New ClaimsXten™ Rules to be Implemented April 2020

Jan. 08, 2020

On or after April 20, 2020, we will update the ClaimsXten software database to better align coding with the reimbursement of claim submissions.

These are the changes:

Read More


Reminder: New Online Enrollment Process for 835 EFT and ERA through the Availity® Provider Portal

Jan. 06, 2020

In a November 2019 News and Updates notice, we announced the upcoming launch of a new online Electronic Funds Transfer (EFT) and Electronic Remittance Advice (ERA) enrollment option. This new capability is now available in the Availity Portal using the multi-payer Transaction Enrollment tool.

Read More