Availity® Provider Portal Offerings

Oct. 13, 2020

The Availity provider engagement portal helps providers and Blue Cross and Blue Shield of Montana (BCBSMT) to securely share information easily and efficiently. Using Availity allows you to quickly verify patient eligibility and benefits, confirm prior authorization requirements, submit prior authorization requests, check claim status, obtain provider claim summaries, and more without having to call BCBSMT.

Advantages of using Availity

  • Accessible 24/7
  • HIPAA Compliant
  • Multi-Payer Solution
  • Real-time Search Results
  • No Cost Transactions
  • Printable Results
  • Online Help Features

Electronic Provider Tools
The following complimentary self-service tools are accessible through Availity and can be used to accomplish multiple tasks and gain information.


Pre-Service Tools

Description

Eligibility and Benefits Inquiry

verify real-time patient activity, check coverage details and determine prior authorization requirements

Patient Care Summary

consolidated view of a patient’s health care history

Patient ID Finder*

obtain the BCBSMT patient ID and group number

Attachments*

submit predetermination of benefits requests handled by BCBSMT

Authorizations

submit prior authorization requests handled by BCBSMT

Pre-Service Tools

Description

Claim Status

check detailed, real-time claim status

Research Procedure Code Edits
(Clear Claim Connection)*

determine how coding combinations on a specific claim may be evaluated during the adjudication process

Reporting On-Demand

view, download, save and/or print the Provider Claim Summary (PCS) for finalized claims

Remittance Viewer

offers providers and billing services a convenient way to view and help reconcile claim data in the 835 Electronic Remittance Advice (ERA)

Electronic Refund Management (eRM)*

reconcile claim overpayments and manage refund requests

Claim Inquiry Resolution (CIR)*

submit claim reconsideration request for certain finalized claims

Medical Attachment
(Electronic Quality and Risk Adjustment Medical Records Requests)

receive and electronically respond to medical record requests for quality and risk adjustment

Clinical Quality Validation (CQV)

comply with Healthcare Effectiveness Data and Information Set (HEIDIS) measures by electronically documenting the patient’s care and assessment


*Not available for Medicare Advantage members.

If you have not yet registered for Availity Learn more about third-party links, you can sign up today at no charge. For registration assistance, you may contact Availity Client Services at 800-282-4548.

For More Information
Refer to the Provider Tools section of our website for detailed information and applicable user guides for the Availity offerings. Additionally, you can visit our Training page to register for upcoming online training sessions.

Have additional questions or need customized training? Email our Provider Education Consultants for assistance.

Checking eligibility and/or benefit information is not a guarantee of payment. Benefits will be determined once a claim is received and will be based upon, among other things, the member’s eligibility and the terms of the member’s certificate of coverage applicable on the date services were rendered. If you have any questions, please call the number on the member’s ID card.

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 any products or services provided by third party vendors such as Availity. If you have any questions about the products or services provided by such vendors, you should contact the vendor(s) directly.

ClaimsXten and Clear Claim Connection are trademarks of Change Healthcare, an independent company providing coding software to BCBSMT. Change Healthcare is solely responsible for the software and all the contents. Contact the vendor directly with any questions about the products, software and services they provide.