Jul. 31, 2020
Our current electronic preauthorization and predetermination of benefits request tool, iExchange, will be deactivated on August 17, 2020. As of this date, all electronic preauthorization and predetermination requests handled by Blue Cross and Blue Shield of Montana (BCBSMT) should be submitted online via the Availity® Provider Portal.
How to Submit Online Preauthorization Requests
Preauthorization requests for inpatient and select outpatient services handled by BCBSMT may be submitted online using Availity’s Authorizations tool. Refer to the educational Availity Authorizations User Guide, located in the Provider Tools section of our website for navigational assistance.
The process of submitting preauthorization requests to eviCore healthcare (eviCore) or other vendors has not changed.
Check the patient’s eligibility and benefits online first to determine if the service requires preauthorization. For online assistance, refer to the General Eligibility and Benefits Expanded User Guide .
How to Submit Online Predetermination of Benefits Requests
As of July 30, 2020, predetermination of benefit requests handled by BCBSMT can be submitted electronically using Availity’s Attachments tool. Watch for the new Electronic Predetermination of Benefits user guide coming soon to the Provider Tools section.
As a reminder, predetermination of benefits is a process used to submit requests for review of coverage decisions in accordance with medical policy and member contracts for a service (i.e., procedure, supply, drug or device) used to diagnose or treat an illness or condition. A predetermination is recommended if a provider is uncertain if the service meets medical policy criteria.
If you don’t have online access, you may continue to fax and/or mail predetermination requests along with a completed Predetermination Request Form and supporting medical documentation. If faxing supporting medical documentation for a previously submitted request, please include the request number.
Submitting predetermination of benefits via Availity does not apply to requests for Medicare Advantage members.
For More Information
You must be registered with Availity to use the Authorizations and Attachments tools. You can sign up today at Availity, at no charge. For registration assistance, call Availity Client Services at 800-282-4548.
If you need further assistance or customized training for these Availity solutions, contact our Provider Education Consultants.
Please note that the fact that a service has been preauthorized/pre-notified, that a guideline is available for any given treatment or that a service or treatment has been 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 any questions, call 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. iExchange is a trademark of Medecision, Inc., a separate company that provides collaborative health care management solutions for payers and providers. eviCore is an independent specialty medical benefits management company that provides utilization management services for BCBSMT. eviCore is wholly responsible for its own products and services. BCBSMT makes no endorsement, representations or warranties regarding any products or services provided by third party vendors such as Availity, eviCore or Medecision. If you have any questions about the products or services provided by such vendors, you should contact the vendor(s) directly.