Blue Distinction® Message Via The Availity® Eligibility And Benefits Results

Aug. 28, 2020

Starting Sept. 1, 2020, the Availity Eligibility and Benefits Inquiry results will include informational Blue Distinction® Center (BDC) messaging for the below specialty care categories when the patient’s policy has a Blue Distinction component. The Availity benefit response will include applicable coverage for the service selected. However, if you need to confirm the specific BDC benefit differential, you will need to call the Customer Service phone number found on the back of the member’s Blue Cross and Blue Shield of Montana (BCBSMT) identification card.

BDCs offer quality care, treatment expertise and better overall patient results. A Blue Distinction® Center+ (BDC+) offers more affordable care in addition to quality, care, cost, treatment expertise, and better overall patient results.

Blue Distinction Specialty Care includes the following categories:

  • Bariatric (weight-loss) surgery
  • Cardiac Care
  • Knee and Hip Replacement
  • Maternity Care
  • Spine Surgery
  • Transplants

For More Information

Find facilities recognized for expertise in bariatric surgery, cardiac care, knee and hip replacement, maternity, spine surgery and transplants on the Blue Distinction® Specialty Care page.

Refer to the Availity Eligibility and Benefits user guide for navigational assistance. If you need further assistance or customized training, contact our Provider Education Consultants.

This information in this notice is not applicable to Medicare Advantage members.

A Local Blue Plan may require additional criteria for providers located in its own service area; for details, contact your Local Blue Plan. Blue Distinction® National criteria for BDC and BDC+ are displayed on Individual outcomes may vary. Neither Blue Cross and Blue Shield Association nor any Blue Plans are responsible for non-covered charges or other losses or damages resulting from Blue Distinction or other provider finder information or care received from Blue Distinction® or other providers.

Trademarks are the property of their respective owners.

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. BCBSMT makes no endorsement, representations or warranties regarding any products or services provided by third party vendors such as Availity. If you have any questions about the products or services provided by such vendors, you should contact the vendor(s) directly.

The information in this article is being provided for educational purposes only and is not the provision of medical care or advice. Physicians and other health care providers are to their own best medical judgment based upon all available information and the condition of the patient in determining the best course of treatment. The fact that a service or treatment is described in this material is not a guarantee that the service or treatment is a covered benefit and members should refer to their certificate of coverage for more details, including benefits, limitations and exclusions. Regardless of benefits, the final decision about any service or treatment is between the member and their health care provider.