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

Oct. 23, 2019

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

What is Advance Member Notification?

AMN refers to the process in which a BCBSMT Participating Provider informs a BCBSMT Member that a service, supply, device, or drug may not be a Medically Necessary covered service prior to the service being performed.

Participating Providers agree they will not bill Members for services BCSBMT denies as not Medically Necessary. However, through the AMN process, the Member may make an informed decision to assume potential financial responsibility for the service if the Member chooses to proceed with the service. With an appropriately completed AMN form for the specific services, the Participating Provider can bill the Member for services denied as not Medically Necessary.

What Has Changed?

Effective 1/1/2020 the AMN process has been expanded to include participating facility providers. Additionally, all Participating Providers are required to submit the NEW BCBSMT AMN Form with their claim to ensure appropriateness and accurate application of financial responsibility.

For complete information please review the Provider Compensation Policy available on the Secure Provider Portal.

The NEW AMN Form is available on the BCBSMT provider website Forms and Documents page.

For questions, please contact your Provider Network Consultant.