Provider Online Services
Important Update Regarding Members and Groups
If you are confirming eligibility information for January 1, 2014 and after, it is possible that you are viewing termination dates of February 28, 2014 for members in error. Blue Cross and Blue Shield of Montana (BCBSMT) is currently in the process of converting eligibility for multiple members on multiple employer groups. For accurate eligibility, please contact Customer Service at 800-447-7828.
You may begin to see patients who have purchased new health insurance coverage with BCBSMT for benefits beginning January 1, 2014. You may have patients who have purchased health insurance coverage but have not yet received their member ID cards. For accurate eligibility, please contact Customer Service at 800-447-7828 to confirm eligibility and benefits for members without ID cards, and be ready to provide the following information:
- Subscriber name
- Patient name
- Patient date of birth
- Patient mailing address
- Last 4 digits of the patient SSN
- Effective date of coverage
As with any other member, eligibility and benefits may vary depending on the coverage purchased by the member, and it is important for providers to check for eligibility and benefits each time they see a patient.
Please review the information below for updates and new items available to our providers using the Provider Online Services. Recent changes include dental benefit summary information as well as access to your Provider Claim Summary (PCS) reports from our new processing system.
Search by Sub ID — When searching for a member, it's best to enter the complete ID including the alpha prefix. If you enter the ID without an alpha prefix, review the results closely to determine the member you wish to view. Results may return for other members on our new processing system who have the same ID, but different alpha prefix.
Note: A Montana member may not have an alpha prefix on his or her dental or vision ID card. In that case, you can also search for the member by entering data in the Last Name, First Name, and Date of Birth fields.
Search by Name and Birth Date — This area of the Member Search section requires the Last Name, First Name, and Date of Birth to initiate a search for the member.
Search Results — Search results will vary depending on whether or not the member has converted to BCBSMT's new processing system.
- Check the group number column before clicking on Member Details. Members being converted to our new system will receive separate ID cards for medical, dental, and vision. Each card includes the group number specific to those benefits. All new group numbers will be six digits in length.
- For information prior to the member's conversion, the group number will be nine digits in length.
Note: If the member is connected to a single group, the search will take you directly to the Member Details.
Click on the Member Details link to display the eligibility screen. The top portion of the page will include the member's complete Sub ID and Group Number for that enrollment. The product type tied to this enrollment will also be displayed for members who have converted.
Select Benefits, Claims and Ded/OOP under the View Selection area and Click on Go.
Benefits — The benefit presentation will be different for those members who have converted to our new processing system.
- The Benefit Plan Summary grid will be available for the medical policy information on converted members. If you require additional benefit details for a specific service type, submit a HIPAA 270 request by accessing the BlueExchange/FEP menu item located on the left navigation area.
- Providers will continue to view member benefit information as they do today for any nonconverted member as well as historical data for any converted member. To see the historical data, select the Member Details tied to the nine-digit group number.
- Dental benefit summary information is available if you select the enrollment tied to the benefit policy.
NOTE: Detailed vision benefits for members on BCBSMT’s new system will not be available initially.
- Select the Ded/OOP under the View Selection area to view the amounts met to date for the member.
- Providers will continue to view member Ded/OOP information as they do today for any nonconverted member as well as historical data for any converted member. To see the historical data, select the Member Details tied to the nine-digit group number.
- If the details of the Ded/OOP met do not satisfy your needs, you can also submit a HIPAA 270 request by accessing the BlueExchange/FEP menu item located on the left navigation area. Select the Service Type Code that fits the benefit category you wish to review in detail. The NPI is required as well as the Place of Service. The information submitted will determine the specific deductible and out-of-pocket information as well as remaining amounts left to satisfy.
Claim Summary and Detail — Claims submitted by your office will be accessible under the corresponding Member Details.
- To view medical, dental, or vision claims processed prior to the member's conversion or for a member who has not converted, select the Member Details for the enrollment tied to the nine-digit group number.
- To view medical claims submitted for the member after he or she has converted, select the new group number Member Details.
- To view dental claims, select the group number that matches the number on the dental ID card.
Note: At this time the dental claims do not include line details.
- To view vision claims, select the group number that matches the number on the vision ID card.
Provider Reports (PCR, PCS, and PCS FEP)
Providers will continue to access online PCRs generated in Montana as they do today.
Update: Beginning April 26, you will have the option to view the Provider Claim Summary (PCS) reports from our new processing system. In addition to PCR, you will be able to select PCS and PCS FEP reports. The PCS and PCS FEP items will be available for reports generated as of 12/18/2013 to the current date.
Clear Claim Connection (C3)
This is a web-based code auditing reference tool available to participating providers.
- Select Clear Claim Connection located under the left navigation area.
- Click on Continue to access the tool that will open in a new window.
- Enter generic patient information and procedure codes and submit to view results.