Healthy Montana Kids Temporary State of Emergency Preauthorization Changes
Effective April 23, 2020, Healthy Montana Kids (HMK), Children's Health Insurance Plan is waiving preauthorization (PA) requirements, with the below exceptions:
- Out-of-Network Services
- Outpatient Pharmacy
- Physician Administered Drugs
- DME items reimbursed over $5,000
- Audiology and Hearing Aid Services
- Home Infusion Therapy
- Personal Transportation
This will be in effect for the duration of the state of emergency declared via Executive Orders 2-2020 and 3-2020.
Post service medical necessity review will occur on submitted claims for all services requiring PA during this period. Blue Cross Blue Shield of Montana (BCBSMT) will still accept and review preauthorization requests for providers seeking review before the service is provided.