Dec. 24, 2025
We’re making changes to prior authorization requests for members with Healthy Montana Kids.
What’s changing: Effective Jan. 1, 2026, Carelon Medical Benefits Management will replace EviCore healthcare for prior authorization requests. Some prior authorization requests previously reviewed by EviCore will now be reviewed by Carelon or Blue Cross and Blue Shield of Montana.
Effective for dates of service on or after Jan. 1, 2026, prior authorization requests should be submitted to Carelon for the following care categories:
- Genetic testing
- Medical oncology
- Musculoskeletal (spine only)
Refer to our website for details on how to submit prior authorization requests. For a list of codes for services in each category where prior authorization is required for Healthy Montana Kids, see our prior authorization lists.
What’s not changing: Prior to rendering care and services for members with Healthy Montana Kids, check eligibility and benefits through Availity® Essentials or your preferred vendor. This step helps confirm if prior authorization is required for a specific service and member. You’ll also be directed to the appropriate utilization management vendor, if applicable, to submit your request for review.
How to submit prior authorization requests through Carelon for Healthy Montana Kids: Beginning Jan 1, 2026, contact Carelon for prior authorization requests for dates of service on or after Jan. 1, 2026.
- Online – The Carelon Provider Portal is available 24/7.
- Phone – Call Carelon at 844-377-1285, Monday through Friday, 6 a.m. to 6 p.m. MT.
You must register with Carelon to access their online portal. If you’re already registered with Carelon to submit prior authorization requests for our commercial members, you don’t need to register again.
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 healthcare is an independent specialty medical benefits management company that provides utilization management services for BCBSMT.
Carelon Medical Benefits Management (Carelon) is an independent company that has contracted with Blue Cross and Blue Shield of Montana to provide utilization management services for members with coverage through BCBSMT.