Sept. 2, 2025
Beginning Oct. 1 2025, we are making changes to some medical policies due to updates in utilization management.
What you need to know:
These medical policy changes will align our policies with updated guidelines for determining medical necessity and new definitions for clinical review and standards of care.
Where can I find Medical Policies?
Approved, new or revised medical policies and their effective dates are usually posted on our website the first and 15th of each month. You can view all active and pending policies, as well as draft medical policies, and provide comments on draft policies. These policies may impact your reimbursement and your patients’ benefits.
Important Reminder: Always check eligibility and benefits first through Availity® Essentials or your preferred vendor portal, prior to rendering services. This step will confirm prior authorization requirements and utilization management vendors, if applicable.
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.