Provider Tools

The following online tools are available to you and your practice at no cost. They are designed to help you streamline billing and evaluate costs.  

You can access many of the web-based tools listed below through Availity® Essentials. If you don’t yet have an Availity Essentials account, register for an account here at no cost to you or call Availity Client Services at 800-282-4548.

Some tools may not be available for government programs. Contact your Network Representative if you have questions.

Attachments – Recommended Clinical Review Requests

Submit recommended clinical review requests handled by BCBSMT with this tool in Availity Essentials. Learn more

Authorizations

Submit prior authorization requests handled by BCBSMT with this tool in Availity Essentials. Learn more

Avalon

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. Learn more

BlueApprovRSM

Access this tool in Availity Essentials to submit inpatient and outpatient prior authorization requests and check the status of your requests. You can also use BlueApprovR to submit recommended clinical review requests. Learn more

Claim Inquiry Resolution – High-Dollar, Pre-Pay Reviews

Access this tool in our Electronic Refund Management system through Availity Essentials. Through CIR you can submit inquiries related to high-dollar, prepay review requests for most BlueCard® out-of-area and local Montana claims (medical records and itemized bills) handled by BCBSMT. Learn more

Claim Reconsideration Requests 

Electronically submit claim reconsiderations for situational finalized claim denials − including BlueCard out-of-area claims − using Availity Essentials' Dispute Claim capability. It is anchored off the enhanced Claim Status tool. Learn more

Claim Status 

Manage and resolve claims processed by BCBSMT using this Availity Essentials tool. It offers enhanced, real-time claim status information. Learn more

Clear Claim ConnectionTM

Learn how coding combinations on a particular claim may be evaluated during the adjudication process using this tool in Availity Essentials. C3 mirrors the logic behind BCBSMT's code-auditing software. Learn more

CoverMyMeds®

Use CoverMyMeds to submit electronic prior authorization requests for prescription drugs that are part of the pharmacy PA program

Electronic Claim Submission

Quickly submit electronic professional (ANSI 837P) and facility or institutional (ANSI 837I) claims or encounters to BCBSMT using this Availity Essentials tool. Learn more

Electronic Clinical Claim Appeal Requests 

Electronically submit appeal requests for specific clinical claim denials through this dispute tool in Availity Essentials. Learn more

Electronic Refund Management

Use this tool to simplify overpayment reconciliation and related processes. You can access it in Availity Essentials. Learn more

Eligibility and Benefits

Quickly obtain detailed benefits information for our members using Availity Essentials’ Eligibility and Benefits Inquiry. This tool provides co-payment, co-insurance, deductible and other important information. 

Verify membership and check coverage details for every patient at every visit, before you administer treatment. Learn more

Fee Schedules (Professional Providers)

With the Availity Essentials Fee Schedule Listing tool, participating professional providers in our networks can electronically request up to 20 procedure codes and immediately receive the contracted price allowance for the services performed. Learn more

Manage My Organization

Administrators and administrator assistants can use this tool in Availity Essentials to add, edit and delete provider information within your organizations for easy data entry when submitting transactions via Availity handled by BCBSMT. Learn more

Medical Record Status Viewer

Confirm receipt of up to four of the most recent medical records submitted by mail or fax to BCBSMT for claim processing and prior authorizations. Access this tool in Availity Essentials. Learn more

Message This Payer

Send secure messages to BCBSMT in Availity Essentials about claim management questions and follow along with the conversation history. Learn more

National Drug Code Units Calculator

Use this tool in Availity Essentials to easily convert applicable classified or specified Healthcare Common Procedure Coding System or Current Procedural Terminology (CPT®) codes to NDC units. Learn more

OptiNet® Assessment Tool

Use this tool to provide modality-specific data from imaging. Developed by Carelon Medical Benefits Management, this tool is an enhancement to our Advanced Imaging Utilization Management program, which Carelon administers for BCBSMT. Learn more

Patient Care Summary

Access this tool in Availity Essentials for an electronic health record based on the last 24 months of claims data. BCBSMT collects the claims-based information from physicians, pharmacies, labs and other health care providers. Learn more

Patient Cost Estimator

Using this Availity Essentials tool, professional and institutional providers can estimate our members’ potential out-of-pocket costs in real time. Learn more

Patient ID Finder

Obtain our members’ ID number and group number by entering patient-specific date elements using this tool in Availity Essentials. Learn more

Physician Efficiency, Appropriateness, & QualitySM Program

Our PEAQSM program evaluates physician performance in a transparent and multidimensional way. Learn more

Plan Documents Viewer

Providers contracted with BCBSMT can view, download and save National Drug Code Fee Schedules using this tool in Availity Essentials. Learn more

Provider Claim Summary

You can readily view, download, save and print Provider Claim Summary reports online using this application in Availity Essentials. Learn more

Provider Correspondence Viewer

Participating providers with BCBSMT can view, download and save specific documents related to the NPI and Tax ID associated with your Availity Essentials registration. Access this tool in Availity Essentials. Learn more

Provider Data Management (PDM)

Professional, facility and ancillary providers can quickly update, validate and attest to the accuracy of your information using this Availity Essentials tool. Learn more

Remittance Viewer

Providers and billing services can view and help reconcile claim data provided by BCBSMT in the 835 Electronic Remittance Advice using this Availity Essentials tool. Learn more

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 third party vendors and the products and services they offer.