Addition Of New Preauthorization Requirements For Montana Members

Oct. 23, 2019

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

  • Outpatient provider administered drug therapies, including Cellular Immunotherapy, Gene Therapy and other medical benefit drug therapies.

View the complete code list here.

For other services requiring preauthorization through BCBSMT, use iExchange® to preauthorize those services. Refer to our iExchange web page for more information or to set up an iExchange account.

Preauthorization through BCBSMT may also be requested by calling the phone number listed on the member/participant’s ID card.

Going forward, it is critical to use Availity® or your preferred vendor to check eligibility and benefits, determine if you are in-network for your patient and whether any preauthorization or predetermination is required. Availity allows you to determine if preauthorization is required based on the procedure code. Refer to “Eligibility and Benefits” under “Claims and Eligibility” at web site for more information on Availity. Providers can also refer to the Predetermination and Preauthorization under “Claims and Eligibility” for assistance.

As a reminder, it is important to check eligibility and benefits prior to rendering services. This step will help you determine if benefit preauthorization is required for a particular member. For additional information, such as definitions and links to helpful resources, refer to the Eligibility and Benefits section on BCBSMT’s provider website.

Please note that verification of eligibility and benefits, and/or the fact that a service or treatment has been preauthorized or predetermined for benefits is not a guarantee of payment. Benefits will be determined once a claim is received and will be based upon, among other things, the member’s eligibility and the terms of the member’s certificate of coverage applicable on the date services were rendered. If you have questions, contact the number on the member’s ID card.

iExchange is a trademark of Medecision, Inc., a separate company that offers collaborative health care management solutions for payers and providers.

Availity is a trademark of Availity, L.L.C., a separate company that operates a health information network to provide electronic information exchange services to medical professionals. Availity provides administrative services to BCBSMT.

BCBSMT makes no endorsement, representations or warranties regarding any products or services offered by Availity or Medecision. The vendors are solely responsible for the products or services they offer. If you have any questions regarding any of the products they offer, you should contact the vendor(s) directly.