2021 News and Updates

Eligibility & Benefit Inquires

Sep. 17, 2021

Starting September 1, 2021 eligibility and benefits will no longer be able to be retrieved from the Montana Secure Provider Portal. Please use Availity Learn more about third-party links for any eligibility and benefit inquires.

Read More


Coding Cancer and Cancer-Related Treatments

Sep. 14, 2021

One in three people in the U.S. will be diagnosed with cancer in their lifetime, according to the American Cancer Society . Accurately and completely coding and documenting cancer and cancer-related treatments may help improve member outcomes and continuity of care.

Read More


Earn CME/CEU Credit at Free Webinar on Comorbid Conditions

Sep. 06, 2021

Join our board-certified psychiatrists and behavioral health medical directors for a one-hour webinar on comorbid behavioral health and physical health conditions. The free webinar is on Friday, Oct. 29, 2021, at 8 a.m. Mountain time. Those attending will earn one continuing medical education (CME) credit or continuing education unit (CEU).

Read More


Coverage Replacement for Smoking Cessation Product CHANTIX® Due to Voluntary Recall

Sep. 06, 2021

Drug manufacturer Pfizer has issued a voluntary recall of its CHANTIX smoking cessation product. To help alleviate a shortage of these products, Blue Cross and Blue Shield of Montana (BCBSMT) is temporarily covering Apo-Varenicline (varenicline tartrate) 0.5 mg and 1 mg tablets. The coverage was effective as of Aug. 10, 2021. It doesn’t apply to members in our Medicare Advantage plans.

Read More


ClaimsXten™ Quarterly Update Reminder

Sep. 03, 2021

Blue Cross and Blue Shield of Montana (BCBSMT) will implement its fourth quarter code updates for the ClaimsXten auditing tool on or after December 13, 2021.

Read More


Beginning September 1, 2021 Eligibility and Benefits Will be Retrieved from Availity

Aug. 11, 2021

Read More


Pharmacy Program Updates: Quarterly Pharmacy Changes Effective October 1, 2021 - Part 1

Aug. 10, 2021

Read More


Adhere to HPV and Shingles Vaccine Guidelines

Aug. 09, 2021

Read More


Availity® Claim Status Response Enhancement for Medicare Advantage Claims

Aug. 04, 2021

The Availity Claim Status tool provides enhanced, real-time claim status details to help you manage and resolve your Blue Cross and Blue Shield of Montana (BCBSMT) claims online. You can search for claims by using the member ID or specific claim number and the results provide more detailed information than the HIPAA-standard claim status 276/277 transaction.

Read More


Provider Satisfaction Survey 2021

Jul. 19, 2021

Read More


Delivering Quality Care: Antidepressant Medication Management

Jul. 08, 2021

To support quality care, we are providing information to providers and members to encourage discussions on health topics. Watch for more on health care quality in News and Updates.

Read More


Colorectal Cancer Screening for Members Age 45 to 75

Jul. 08, 2021

In line with new U.S. Preventive Services Task Force Learn more about third-party links (USPSTF) recommendations, Blue Cross and Blue Shield of Montana (BCBSMT) recommends that colorectal cancer screening for our members begin at age 45 rather than 50. We are updating our Preventive Care Guidelines and our claims processing to reflect this change. Screening should continue until age 75.

Read More


Prior Authorization Update - Pharmacy Medical Oncology

Jun. 21, 2021

What’s Changing: Blue Cross and Blue Shield of Montana (BCBSMT) is changing prior authorization requirements for specialty drugs used for oncologic application.

Read More


Update to Current Procedural Terminology (CPT®) Codes for Prior Authorization for Medicare Members

Jun. 21, 2021

What’s Changing: Blue Cross and Blue Shield of Montana (BCBSMT) is changing prior authorization requirements for Medicare and Healthy Montana Kids (HMK) members, to reflect new, replaced or removed codes due to updates from Utilization Management or the American Medical Association (AMA).

Read More


Current Procedural Terminology (CPT®) Codes Updated for Prior Authorization for Commercial Members

Jun. 21, 2021

What’s Changing: Blue Cross and Blue Shield of Montana (BCBSMT) is changing prior authorization requirements that may apply to some commercial members, to reflect new, replaced or removed codes due to updates from Utilization Management or the American Medical Association (AMA). A summary of changes is included below.

Read More


NDC Fee Schedule Update Effective September 1, 2021

Jun. 15, 2021

The Montana provider NDC fee schedule has been updated and will be effective September 1, 2021 for the following drugs/therapies listed below. Blue Cross and Blue Shield of Montana (BCBSMT) Compensation Policies and Fee Schedules are published on the BCBSMT Secure Provider Portal.

Read More


Earn CME/CEU Credit at Free Webinar on Opioid Use

Jun. 09, 2021

Join our board-certified psychiatrists and behavioral health medical directors for a one-hour webinar on opioid use disorder. The webinar is on Friday, Aug. 20, 2021, at 8 a.m. Mountain time. It’s free to providers. Those who attend will earn one continuing medical education credit (CME) or continuing education unit (CEU).

Read More


Closing Gaps in Care for Group Medicare Advantage (MA) Members

Jun. 09, 2021

The Blue Cross and Blue Shield (BCBS) National Coordination of Care program is again serving Blue Cross Group Medicare Advantage (PPO)SM (Group MA PPO) members. The program paused during the global pandemic. As we told you in December 2019, the program supports continuity of care for all BCBS Group MA PPO members.

Read More


Delivering Quality Care: Supporting Mental Health

Jun. 09, 2021

To support quality care, we are providing information to providers and members to encourage discussions on health topics. Watch for more on health care quality in News and Updates.

Read More


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

Jun. 09, 2021

Read More


Prepayment Reviews on Inpatient DRG Claims for BlueCard members

Jun. 03, 2021

Beginning July 1, 2021, the Blue Cross and Blue Shield Association will require Blue Cross and Blue Shield of Montana (BCBSMT) to review select inpatient, diagnosis-related group (DRG) claims before processing. The review will check for compliance with ICD-10 procedure coding system guidelines. For those claims, providers must submit medical records for the claim to process.

Read More


Catch Up Now on Child and Adolescent Vaccinations

May. 27, 2021

Due to COVID-19, children and adolescents have fallen behind on receiving recommended vaccines. The Centers for Disease Control and Prevention (CDC) recommends that children get caught up now with vaccinations so that they’re protected as they return to in-person learning. We encourage providers to schedule catch-up vaccinations as soon as possible and prepare for COVID-19 vaccine protocols.

Read More


In-Home Test Kits for Colorectal Cancer Screening

May. 27, 2021

Blue Cross and Blue Shield of Montana (BCBSMT) is working with Home Access Health Corporation to provide in-home test kits for certain members who need a colorectal cancer screening. Because of the COVID-19 pandemic, many may have delayed getting appropriate care. Home Access Health is sending Fecal Immunochemical Test (FIT) kits to eligible Blue Preferred PPOSM and Blue Focus POSSM members at no additional charge.

Read More


Free Webinar and CME on Depression

May. 17, 2021

Join our board-certified psychiatrists and behavioral health medical directors for a one-hour webinar, Depression in a Primary Care Setting. The webinar is Friday, June 18, 2021, at 8 a.m. Mountain time. It is free to all providers. Those who attend will earn one continuing medical education credit (CME) or continuing education unit (CEU).

Read More


Pharmacy Members Have New Mail Order and Specialty Pharmacies as of May 1

May. 10, 2021

Blue Cross and Blue Shield of Montana (BCBSMT) has chosen new mail order and specialty pharmacy service providers through our pharmacy benefit manager (PBM), Prime Therapeutics LLC (Prime).

Read More


Treating Substance Abuse

May. 10, 2021

To support quality care, we are providing information to providers and members to encourage discussions on health topics. Watch for more on health care quality in News and Updates.

Read More


EXL Health to Review Complex Claims July 1, 2021

May. 10, 2021

Our post-payment reviewer of complex claims is changing. Starting July 1, 2021, EXL Health will conduct post-payment reviews of complex claims from providers and facilities on behalf of Blue Cross and Blue Shield of Montana (BCBSMT). EquiClaim, a Change Healthcare Solution, won’t conduct reviews of complex claims filed after June 30.

Read More


Reminder: Single Access Point for EFT and ERA Enrollments

May. 10, 2021

In the March News and Updates, we announced that as of May 3, 2021, enrollment in Electronic Funds Transfer (835 EFT) and/or Electronic Remittance Advice (835 ERA) must be completed via the Availity® Provider Portal.

Read More


ClaimsXten™ Quarterly Update Reminder

May. 10, 2021
Updated Jun 4, 2021

Blue Cross and Blue Shield of Montana (BCBSMT) will implement the second and third quarter code updates for the ClaimsXten auditing tool on or after August 24, 2021.

Read More


Prepayment Reviews on Inpatient DRG Claims for BlueCard members

May. 04, 2021

Beginning July 1, 2021, the Blue Cross and Blue Shield Association will require Blue Cross and Blue Shield of Montana (BCBSMT) to review select inpatient, diagnosis-related group (DRG) claims before processing. The review will check for medical appropriateness and compliance with ICD-10 procedure coding system guidelines. For those claims, providers must submit medical records for the claim to process.

Read More


Update to Current Procedural Terminology (CPT®) Codes for Prior Authorization for Medicare Members

May. 04, 2021

What’s Changing: Blue Cross and Blue Shield of Montana (BCBSMT) is changing prior authorization requirements for Medicare and HMK members, to reflect new, replaced or removed codes due to updates from Utilization Management or the American Medical Association (AMA).

Read More


Current Procedural Terminology (CPT®) Codes Updated for Prior Authorization for Commercial Members

May. 04, 2021

What’s Changing: Blue Cross and Blue Shield of Montana (BCBSMT) is changing prior authorization requirements that may apply to some commercial members, to reflect new, replaced or removed codes due to updates from Utilization Management or the American Medical Association (AMA). A summary of changes is included below.

Read More


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

Apr. 29, 2021

Read More


Documentation and Coding: Major Depressive Disorder

Apr. 10, 2021

Depression is the most common mental disorder. It carries a high cost in terms of relationship problems, family suffering and lost work productivity, according to the American Psychiatry Association Learn more about third-party links. Accurately and completely documenting and coding Major Depressive Disorder (MDD) can help our members access needed resources. Below is information from the ICD-10-CM Official Guidelines for Coding and Reporting Learn more about third-party links.

Read More


Provider Satisfaction Survey 2021

Apr. 08, 2021

Building a strong network of providers and working with you to serve our members is important to us. To support this effort we survey a random sample of providers each year. The Provider Satisfaction Survey measures your satisfaction with Blue Cross and Blue Shield of Montana (BCBSMT) and identifies areas where we can improve.

Read More


New Applied Behavior Analysis (ABA) Service Request Forms

Apr. 01, 2021

As of March 2021, we’ve updated our ABA service request forms to streamline data required for review.

Read More


Delivering Quality Care: Caring for the Colon

Mar. 31, 2021

To support quality care, we are providing information to providers and members to encourage discussions on health topics. Watch for more on health care quality in News and Updates.

Read More


Delivering Quality Care: Cervical Cancer Screening May Save a Life

Mar. 31, 2021

To support quality care, we are providing information to providers and members to encourage discussions on health topics. Watch for more on health care quality in News and Updates.

Read More


NDC Fee Schedule Update Effective June 1, 2021

Mar. 25, 2021

The Montana provider NDC fee schedule has been updated and will be effective June 1, 2021. Blue Cross and Blue Shield of Montana (BCBSMT) Compensation Policies and Fee Schedules are published on the BCBSMT Secure Provider Portal.

Read More


Single Access Point for EFT and ERA Enrollments

Mar. 23, 2021

Starting May 3, 2021, Blue Cross and Blue Shield of Montana (BCBSMT) will offer a single access point for enrollment in Electronic Funds Transfer (835 EFT) and/or Electronic Remittance Advice (835 ERA) via the Availity® Provider Portal. As of this date, faxed or mailed EFT or ERA enrollment applications including change/cancel requests will be returned and redirected to the electronic option.

Read More


Select Medication List to be Updated June 1, 2021

Mar. 23, 2021

The viscosupplement products on the Select Medication List will be updated effective June 1, 2021.

Read More


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

Mar. 23, 2021

Read More


Health Care Quality: Blood Pressure Control - Speaking Out About the ‘Silent Killer’

Mar. 13, 2021

To support quality care, we are providing information to providers to encourage discussions with members on health topics. Watch for more on health care quality in News and Updates.

Read More


Please Encourage Patients to Respond to CAHPS Survey if Selected to Participate

Mar. 13, 2021

Read More


Telemedicine Expansion for 2021

Feb. 26, 2021

We are working to finalize the details and update our website with the following information as quickly as we can.

In support of our members and employer groups during the ongoing national public health emergency (PHE), and in line with the new administration’s information that we expect the PHE to continue for the duration of 2021, we are expanding the telemedicine services we’ll cover through the end of 2021. This means that we are no longer limiting coverage of telemedicine services to the Centers for Medicare and Medicaid Services (CMS) and American Medical Association (AMA) permanent lists.

Read More


CPT Category II Codes Can Help Close Care Gaps

Feb. 26, 2021

Using the proper Current Procedural Terminology (CPT®) Category II codes when filing claims can help streamline your administrative processes and ensure gaps in care are closed.

Read More


Single Access Point for 835 EFT and ERA Enrollments

Feb. 26, 2021

Starting May 3, 2021, Blue Cross and Blue Shield of Montana (BCBSMT) will offer a single access point for enrollment in Electronic Funds Transfer (835 EFT) and/or Electronic Remittance Advice (835 ERA). As of this date, faxed or mailed EFT or ERA enrollment applications including change/cancel requests will be returned and redirected to the electronic option.

Read More


Overpayment Recovery for Multiple Surgical Procedures

Feb. 12, 2021

On June 1, 2021, Blue Cross and Blue Shield of Montana (BCBSMT) will begin additional reviews of claims after payment to make sure they adhere to our reimbursement policy for multiple surgical procedures.

Read More


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

Feb. 04, 2021

Read More


Documentation and Coding Guidance - Diabetes Mellitus

Feb. 01, 2021

High quality documentation and complete, accurate coding can help capture our members' health status and promote continuity of care. Below are resources for documenting and coding diabetes mellitus (DM). This information is from the ICD-10-CM Official Guidelines for Coding and Reporting Learn more about third-party links and the sources listed below*.

Read More


Documentation and Coding Guidance - Atrial Fibrillation

Feb. 01, 2021

High quality documentation and complete,accurate coding can help capture our members' health status and promotecontinuity of care. Below are resources for documenting and coding atrialfibrillation (AF). This information is from the ICD-10-CM Official Guidelines for Coding and Reporting and the sources listed below*.

Read More


Healthy Montana Kids Adopts Bright Futures Screening Tools

Jan. 26, 2021

The Healthy Montana Kids program has adopted the Bright Futures/American Academy of Pediatrics Recommendations for Preventive Pediatric Health Care and wants to remind providers of the importance and availability of these screening tools.

Read More


Telemedicine 2021

Jan. 18, 2021

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. The experience confirmed the importance of telemedicine in health care delivery. Members can access their medically necessary, covered benefits through providers who deliver services through telemedicine. Many of our members also have access to various telemedicine vendors, such as MDLIVE.

Read More


Remember to Complete a Required CAQH Profile When Onboarding New Providers to the Network

Jan. 15, 2021

We are updating the Join Our Network onboarding process beginning February 1, 2021 to improve the processing time for contracting and credentialing new providers.

Read More