2021 News and Updates

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

Dec. 30, 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).

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

Dec. 30, 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.

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New Lab Policies and Laboratory Management Program Delayed

Dec. 29, 2021

BCBSMT has postponed the Jan. 1, 2022 launch of new lab policies and laboratory program.

Watch News and Updates for future updates on this program.

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Webinar on Avoiding Antibiotics Overuse

Dec. 20, 2021

You're invited to watch a recording of our free webinar on preventing antibiotics overuse. The webinar features Dr. Sharon Tsay, a medical officer from the Centers for Disease Control and Prevention (CDC) Office of Antibiotic Stewardship. It was recorded Nov. 16, 2021.

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Claim Editing Enhancements Coming April 1, 2022

Dec. 17, 2021

Effective April 1, 2022, Blue Cross and Blue Shield of Montana (BCBSMT) will enhance our claims editing and review process with Cotiviti, INC. for some of our commercial members to help ensure accurate coding of services and that services are properly reimbursed.

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Rural Health Clinics and Federally Qualified Health Centers May Meet Quality Measure

Dec. 16, 2021

Starting Jan. 1, 2022, Rural Health Clinics (RHC) and Federally Qualified Health Centers (FQHC) may meet the requirements for the quality measure Follow-up After Hospitalization for Mental Illness (FUH). We track FUH as part of monitoring the quality of our members’ care.

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Availity® Tools to Support Providers in 2022

Dec. 10, 2021

In November we highlighted changes starting Jan. 1, 2022, for the Consolidated Appropriations Act (CAA) of 2021 and the Transparency in Coverage Final Rule. To further support you, the Availity Provider Portal Learn more about third-party links helps providers and Blue Cross and Blue Shield of Montana (BCBSMT) quickly and securely share information, including information defined by the CAA.

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2022 Federal Employee Program Benefit Changes

Dec. 10, 2021

Please confirm the benefits prior to submission with the 2022 Federal Employee Program Service
Benefit Plan Brochure for Standard and Basic Option or Blue Focus Option

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New Flexible Medicare Advantage PPO Plan

Dec. 10, 2021

We're offering certain Blue Cross Medicare Advantage? members a new way to access care. The Blue Cross Medicare Advantage Flex (PPO)? Plan is an open access plan. It allows members to see any provider accepting Medicare, including Blue Cross Medicare Advantage (PPO)? and Blue Cross Medicare Advantage (HMO)? contracted providers. Members can see providers inside or outside the plan service area or plan network, at no additional cost.

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Pharmacy Program Updates: Quarterly Pharmacy Changes Effective Jan. 1, 2022 – Part 1

Dec. 06, 2021

Some Blue Cross and Blue Shield of Montana (BCBSMT) members’ plans may have experienced changes to the pharmacy network as of Jan. 1, 2022. Some members’ plans may have moved to a new pharmacy network and some members’ plans may experience changes to the pharmacies participating within the network.

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Patients in the Qualified Medicare Beneficiary Program Should Not Be Billed

Dec. 03, 2021

If you participate in Blue Cross Medicare AdvantageSM plans, you may not bill our members enrolled in the Qualified Medicare Beneficiary (QMB) program, a federal Medicare savings program.

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Hospitals Must Provide Medicare Outpatient Observation Notice

Dec. 03, 2021

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.

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COVID-19 Vaccine Billing for Medicare Advantage Members

Nov. 25, 2021

Starting Jan. 1, 2022, Blue Cross and Blue Shield of Montana (BCBSMT) will cover the cost of COVID-19 vaccines and their administration for Blue Cross Medicare Advantage members instead of the Original Medicare program (also known as fee-for-service Medicare). Medicare Advantage members will continue to have no cost-sharing during their 2022 benefit year for COVID-19 vaccines and their administration, including approved booster doses.

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Third Quarter Blue Review

Nov. 24, 2021

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Single Sign-On Access to AIM Specialty Health® via Availity®

Nov. 19, 2021

Checking patient eligibility and benefits is an imperative first step to confirm coverage and prior authorization requirements before rendering services. The Availity Eligibility and Benefits Inquiry allows you to quickly confirm prior authorization requirements, along with contact information for the utilization management vendor, if applicable.

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Provider Directory Information Verification

Nov. 18, 2021

The Consolidated Appropriations Act (CAA) requires provider directory information to be verified every 90 days. Providers and insurers have roles in fulfilling this requirement to maintain an accurate directory.

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New Information on Member ID Cards

Nov. 15, 2021

The Consolidated Appropriations Act requires that member ID cards include deductible information and out-of-pocket maximums. We will provide all members with updated electronic ID cards that include this information.

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Machine-Readable Files

Nov. 12, 2021

Requirement of the Transparency in Coverage Final Rule

Health insurers are required to publicly display certain health care price information via machine-readable files on their websites beginning in 2022. These machine-readable files will include negotiated rates with in-network providers, allowed amounts for out-of-network providers and may include prescription-drug pricing. The Departments of Health and Human Services (HHS), Labor and Treasury have issued guidance indicating they will delay their enforcement of the machine-readable file requirements until July 1, 2022.

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Surprise Billing Provisions of No Surprises Act

Nov. 11, 2021

The No Surprises Act (NSA) is part of the Consolidated Appropriations Act (CAA). Under NSA, most out-of-network providers will no longer be allowed to balance bill patients for:

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Consolidated Appropriations Act & Transparency in Coverage Final Rule

Nov. 10, 2021

The Consolidated Appropriations Act (CAA) of 2021 and the Transparency in Coverage Final Rule will impact many of our members starting Jan. 1, 2022. As providers caring for our members, you may be impacted as well.

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

Nov. 10, 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).

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Update: Professional Provider Fee Schedule Listing via Availity®

Nov. 10, 2021

In the December 2020 News and Updates, we announced the launch of the Fee Schedule Listing tool via the Availity Provider Portal. This tool was recently updated to allow professional providers participating in the following networks to immediately receive the contracted price allowance for services you perform:

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Watch for a Letter on Fighting Fraud, Waste and Abuse

Nov. 09, 2021

Every year analysts and investigators for Blue Cross and Blue Shield of Montana (BCBSMT) review claims data, industry trends and investigative results to identify potential areas of fraud and waste.

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View Withdrawn Claim Descriptions via the Availity® Claim Status Tool Changes

Nov. 09, 2021

There may be instances when you receive a claim withdrawn notification by mail after submission to Blue Cross and Blue Shield of Montana (BCBSMT). As an alternative method, you may also determine why a claim was withdrawn via the Availity Claim Status tool response.

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Continuity of Care Changes

Nov. 09, 2021

Most of our group and fully insured plans currently include a time period for continuity of care at in-network reimbursement rates when a provider leaves our networks. The new legislation also requires continuity of care for affected members when:

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New Look Ahead for Provider Website

Nov. 02, 2021

Our website for providers will have a new streamlined design by early next year. We’re making changes to enhance your online experience and help you easily find the information that's important to you.

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Montana Senate Bill 217 Psychiatric Collaborative Care and Primary Care Behavioral Health Mandate

Nov. 02, 2021

Montana Senate Bill 217 expands coverage of certain outpatient psychiatric services delivered through the psychiatric collaborative care and primary care behavioral health models.

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Webinar on Avoiding Antibiotics Overuse

Nov. 01, 2021

Register today Learn more about third-party links to join a medical officer from the CDC Office of Antibiotic Stewardship for a webinar on preventing antibiotics overuse. The free webinar is Nov. 16, 2021, from 12:15 to 1 p.m. CT and will provide information on:

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

Oct. 29, 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.

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BCBSMT Moves to Streamline Coordination of Benefits for Members with Secondary Coverage

Oct. 25, 2021

In October, Blue Cross and Blue Shield of Montana (BCBSMT) began working with the Council for Affordable Quality Healthcare (CAQH) to help identify some commercial and Healthy Montana Kids members who have more than one health insurance policy. By leveraging CAQH’s COB Smart® database, we are collaborating with other health insurers to streamline benefit coordination.

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Introducing Electronic Clinical Claim Appeal Requests via Availity® Provider Portal

Oct. 21, 2021

Blue Cross and Blue Shield of Montana (BCBSMT) is excited to announce a new and convenient electronic capability to submit appeal requests for specific clinical claim denials through the Availity Portal. This electronic option allows you to submit the clinical appeal request, upload supporting documentation, and monitor the status.

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Catch Up on Vaccines for All Ages

Oct. 21, 2021

The COVID-19 pandemic has significantly disrupted routine immunizations for children, adolescents and adults, according to the U.S. Department of Health and Human Services Learn more about third-party links. You may hear from our members about catching up on delayed vaccinations. We’ve created resources for them about staying current on routine vaccines. Examples of routine vaccinations include:

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2022 Telemedicine Services

Oct. 20, 2021

In support of our members and employer groups, in 2022 Blue Cross and Blue Shield of Montana (BCBSMT) will continue to cover the expanded telemedicine services that we've covered in 2021.

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Using AIM for Prior Authorization - Coming for Pharmacy Medical Oncology

Oct. 19, 2021

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

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

Oct. 19, 2021

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Contract Requests, Adding New Providers to Existing Groups & Provider Demographic Updates

Oct. 18, 2021

Blue Cross & Blue Shield of Montana is implementing electronic submission for contract requests, adding new providers to existing groups and provider demographic updates. Effective January 01, 2022 Blue Cross & Blue Shield of Montana will no longer be accepting paper submissions.

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Claim Editing Enhancements Coming Jan. 10, 2022

Oct. 18, 2021

Effective Jan. 10, 2022, Blue Cross and Blue Shield of Montana (BCBSMT) will enhance our claims editing and review process with Cotiviti for some of our commercial members to help ensure accurate coding of services and that services are properly reimbursed.

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Delivering Quality Care: Breast Cancer Screening

Oct. 01, 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.

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Updates to Clinical Practice and Preventive Care Guidelines

Sep. 29, 2021

We’ve updated our Clinical Practice Guidelines and Preventive Care Guidelines. The guidelines draw from evidence-based standards of care and nationally recognized medical authorities to help direct our quality and health management programs and help improve member care. They may help guide your decision-making as you care for our members.

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New Laboratory Policies Coming Jan. 1

Sep. 24, 2021

Beginning Jan. 1, 2022, Blue Cross and Blue Shield of Montana (BCBSMT) will implement new medical policies and a new program for claims for certain outpatient laboratory services provided to some of our commercial members. Our new Laboratory Management Program will help ensure our members get the right care at the right time and in the right setting. It will also help you better prepare and submit claims that support and reflect high quality, affordable care delivery to our members.

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Change to Some Primary and Secondary Claims Coordination

Sep. 21, 2021

As of Dec 13, 2021, when a Blue Cross and Blue Shield of Montana (BCBSMT) member has primary and secondary health insurance coverage from two BCBSMT plans or BCBSMT and one of the following four plans listed below, we will be making changes to increase efficiencies in coordinating these claims for our providers.

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Managing Diabetes

Sep. 20, 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.

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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.

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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.

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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).

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

Sep. 06, 2021

9/22/21 update: On Sept. 16, 2021, Pfizer expanded its voluntary recall of Chantix to include all lots of 0.5 mg and 1 mg tablets. We will notify affected members. You may also receive a notification.

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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.

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

Aug. 11, 2021

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

Aug. 10, 2021

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Adhere to HPV and Shingles Vaccine Guidelines

Aug. 09, 2021

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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.

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Provider Satisfaction Survey 2021

Jul. 19, 2021

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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.

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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.

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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.

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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.

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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.

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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).

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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.

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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.

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

Jun. 09, 2021

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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.

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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.

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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.

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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).

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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).

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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.

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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.

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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.

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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.

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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.

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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.

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

Apr. 29, 2021

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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.

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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.

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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.

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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.

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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.

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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.

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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.

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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.

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

Mar. 23, 2021

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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.

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

Mar. 13, 2021

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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.

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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.

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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.

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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.

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

Feb. 04, 2021

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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*.

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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*.

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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.

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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.

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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.

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