Update: Change in Advance Member Notification Process Effective 1/1/2020

Mar. 12, 2020

To improve cost transparency for our Members and provide a more efficient process for our Participating Providers, Blue Cross and Blue Shield of Montana (BCBSMT) has updated our Advance Member Notification (AMN) process. These changes will apply to all lines of BCBSMT business except for Medicare Supplement, Medicare Advantage, and Federal Employee Program effective 1/1/2020.

Effective 1/1/2020 the AMN process has been expanded to include Participating Facility Providers. The policy required the BCBSMT AMN form accompany the claim. Retroactive to 1/1/2020: The updates to the policy are that all Participating Providers must keep an AMN form on file available to BCBSMT upon request or may submit an AMN form with their claim. Additionally, Participating Providers are encouraged to use the BCBSMT AMN form PDF Document which is available on the provider website Forms and Documents page. Providers may use another form which contains all the necessary elements as outlined in the Coding and Compensation Policy.

For complete information please review the Provider Compensation Policy available on the Secure Provider Portal.

What is Advance Member Notification?

AMN refers to the process in which a BCBSMT Participating Provider informs a BCBSMT Member that a service, supply, device, or drug may not be a Medically Necessary covered service prior to the service being performed.

Participating Providers agree they will not bill Members for services BCSBMT denies as not Medically Necessary. However, through the AMN process, the Member may make an informed decision to assume potential financial responsibility for the service if the Member chooses to proceed with the service. With an appropriately completed AMN form for the specific services, the Participating Provider can bill the Member for services denied as not Medically Necessary.

For questions, please contact your Provider Network Consultant PDF Document.