Check Your Patients’ Behavioral Health Preauthorization Requirements

May. 07, 2019

Beginning July 15, 2019, we are improving our claims review process for behavioral health services that require preauthorization. This will result in more consistent and accurate claims payment.

As a reminder, the following behavioral health services typically need preauthorization:

  • Services provided in the following settings:
    • Inpatient acute facilities
    • Residential treatment facilities
    • Partial hospitalization
    • Intensive outpatient therapy
    • Focused outpatient management
  • Psychological or neuropsychological testing
  • Applied behavior analysis

Services performed without preauthorization, if required, may be denied for payment and providers may not seek reimbursement from Blue Cross and Blue Shield of Montana (BCBSMT) members. The plan will conduct a retrospective review for medical necessity after the claim has been submitted.

For more information on behavioral health preauthorization requirements, visit the Behavioral Health Program section of our website. You may submit benefit preauthorization requests online for Intensive Outpatient Program and Electroconvulsive Therapy using our online tool, iExchange®. Refer to our Forms page for behavioral health preauthorization requests and other forms.

You should always check eligibility and benefits for each member before treatment. This step will help you confirm applicable preauthorization requirements. You may check eligibility and benefits online for BCBSMT, out-of-area Blue Plan and Federal Employee Program® (FEP®) members via the Availity® Provider Portal or your preferred vendor portal.

iExchange is a trademark of Medecision, Inc., a separate company that offers collaborative health care management solutions for payers and providers. BCBSMT makes no endorsement, representations or warranties regarding any products or services offered by third party vendors such as Availity and Medecision. If you have any questions about the products or services offered by such vendors, you should contact the vendor(s) directly.