Provider Tools

These complimentary online applications can be used to accomplish tasks and gain information. Some of the tools require registration through a third-party vendor portal, as noted — see our E-Commerce Connections menu for vendor registration details.

Availity® Attachments: Submit Recommended Clinical Review Requests

Attachments is an online tool in the Availity Essentials portal that allows you to submit electronic recommended clinical review (formerly predetermination of benefits) requests handled by Blue Cross Blue Shield of Montana (BCBSMT).

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Availity® Authorizations

Authorizations is an online tool in the Availity Essentials that allows you to submit prior authorization requests handled by Blue Cross and Blue Shield of Montana (BCBSMT).

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Availity Eligibility and Benefits

It is important to verify membership and check coverage details for every patient at every visit, before you administer treatment.

To obtain fast, efficient, detailed benefits information for Blue Cross and Blue Shield members, you can use Availity's Eligibility and Benefits tool. This free online tool can provide you with co-payment, co-insurance, deductible, and other important information.

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Avalon Trial Claim Advice Tool

Avalon Healthcare Solutions has developed a Trial Claim Advice Tool which allows providers to input the procedure codes and diagnoses to view a preliminary determination of how the claim may be reviewed.

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BlueApprovR is an online tool accessible in Availity® Essentials that allows providers to submit inpatient and/or outpatient prior authorization requests and check status for medical and surgical, specialty pharmacy drugs, and behavioral health services, as well as recommended clinical review (RCR) requests for medical/surgical and specialty pharmacy drugs for many BCBSMT commercial members.

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Blue Distinction Centers®

Find facilities recognized for expertise in bariatric surgery, cardiac care, complex and rare cancers, knee and hip replacement, spine surgery, and transplants on the Blue Distinction website.

Claim Inquiry Resolution (CIR) Tool - High Dollar, Pre-Pay Reviews

Claim Inquiry Resolution (CIR) is available via a tab in our Electronic Refund Management (eRM) system. The CIR function provides a method for inquiry submission related to High-Dollar, Pre-Pay Review requests for most Host (BlueCard® out-of-area) claims (Medical Records and/or Itemized Bills) handled by BCBSMT.

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Claim Reconsideration Requests 

The Claim Reconsideration option allows providers to electronically submit claim reconsiderations (including BlueCard® out-of-area claims), using Availity’s Dispute Claim capability anchored off the enhanced Claim Status tool.  

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Claim Status 

The Availity® Essentials Claim Status tool offers enhanced, real-time claim status functionality to help you manage and resolve claims processed by BCBSMT.

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Clear Claim ConnectionTM

Clear Claim Connection (C3) is a free online reference tool that mirrors the logic behind BCBSMT's code-auditing software.* You can use C3 to help determine how coding combinations on a particular claim may be evaluated during the adjudication process.

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Clinical Quality Validation (CQV) Application

Clinical Quality Validation (CQV) is a web-based application in the Availity® Provider Portal that allows providers to quickly comply with Healthcare Effectiveness Data and Information Set (HEDIS®) measures. Providers can electronically document their patient’s care and assessments to close quality HEDIS care gaps for BCBSMT members using CQV.

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CoverMyMeds is an online tool for electronic completion and submission of benefit prior authorization (PA) requests for prescription drugs that are part of the Blue Cross and Blue Shield of Montana (BCBSMT) pharmacy PA program.

Electronic Clinical Claim Appeal Requests 

Dispute Claim allows providers to electronically submit appeal requests for specific clinical claim denials through Availity® Essentials.

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Electronic Claim Submission via Availity® Essentials

Availity’s Claim Submission tool allows providers to quickly submit electronic Professional (ANSI 837P) and facility, or Institutional (ANSI 837I) claims or encounters to Blue Cross and Blue Shield of Montana (BCBSMT), at no cost.

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Electronic Refund Management (eRM)

The Electronic Refund Management (eRM) tool is designed to help simplify claim overpayment reconciliation and related processes.

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Fee Schedules via Availity® (Professional Providers)

The Availity Fee Schedule viewer tool allows professional providers participating with BCBSMT to electronically request a range of up to 20 procedure codes and immediately receive the contracted price allowance for the patient services you perform.

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Manage My Organization in Availity® Essentials

Manage My Organization in Availity Essentials allows administrators and administrator assistants to add, edit, and/or delete provider(s) information within your organization(s)for easy data entry when submitting transactions via Availity handled by BCBSMT.

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Medical Record Status Viewer

The Medical Record Status Viewer is an online application that allows providers to confirm receipt (up to four) of the most recent medical records submitted by mail or fax to Blue Cross and Blue Shield of Montana (BCBSMT) for claim processing and prior authorization requests.

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Message This Payer Application

The Message This Payer application in Availity® Essentials allows providers to send secure messages to Blue Cross and Blue Shield of Montana (BCBSMT) for claim management questions and follow along with the conversation history.

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National Drug Code (NDC) Units Calculator Tool via Availity®

The National Drug Code (NDC) Units Calculator is a user-friendly online tool that allows providers to convert applicable classified or specified Healthcare Common Procedure Coding System (HCPCS) or Current Procedural Terminology (CPT®) codes to NDC units.

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Patient Care Summary

Patient Care Summary is accessible via Availity® Essentials and provides an electronic health record sourced from claim-based information collected by BCBSMT from physicians, pharmacies, labs and other health care providers based on the last 24 months of claims data.

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Patient ID Finder

The Availity® Patient ID Finder tool allows providers to obtain the BCBSMT patient ID number and group number by entering patient-specific data elements.

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Plan Documents Viewer

The Plan Documents Viewer is an application in Availity Essentials that allows providers contracted with Blue Cross and Blue Shield of Montana (BCBSMT) to view, download and/or save the Provider Manuals, Coding and Compensation Policies, and Facility, National Drug Code (NDC) and Resource Based Relative Value Scale (RBRVS) Fee Schedules.

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Provider Claim Summary

The Availity® Provider Claim Summary application allows users to readily view, download, save and/or print Provider Claim Summary (PCS) reports online, at no additional cost. 

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Provider Data Management (PDM)

Provider Data Management (PDM) is a web-based tool in Availity® Essentials that allows professional, facility, and ancillary providers to quickly update, validate and attest to the accuracy of their information on file with Blue Cross and Blue Shield of Montana (BCBSMT).

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Remittance Viewer

The remittance viewer offers providers and billing services a convenient way to view and help reconcile claim data provided by (BCBSMT) in the 835 Electronic Remittance Advice (ERA).

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