Jan. 20, 2020
Claims and Eligibility
Education and Reference
Standards and Requirements
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:
Services Requiring Prior Authorization
The new requirements apply to the following outpatient services:
There are two ways to secure a prior authorization through eviCore:
Requirements Vary by Member
Prior authorization requirements are specific to each member based on their benefit plan. Check eligibility and benefits before rendering services. Submitting an electronic 270 transaction via the Availity® Provider Portal or your preferred vendor portal provides information about:
Obtaining benefit prior authorization is not a substitute for checking eligibility and benefits. We will not pay for services performed without required benefit prior authorization. Providers may not seek reimbursement from BCBSMT members. If you have any questions, contact the number on the member’s ID card.
Availity is a trademark of Availity, LLC, a separate company that operates a health information network to provide electronic information exchange services to medical professionals. Availity provides administrative services to BCBSMT. eviCore is an independent specialty medical benefits management company that provides utilization management services for BCBSMT. BCBSMT makes no endorsement, representations or warranties regarding any products or services provided by third party vendors such as Availity or eviCore. If you have any questions about the products or services provided by such vendors, you should contact the vendor(s) directly.