Preauthorization Requirements Changing for BCBSMT Medicare Advantage Members

Oct. 29, 2020

Effective Jan. 1, 2021, for some MA plan members

What's changing?

Effective Jan. 1, 2021 preauthorization will no longer be required for musculoskeletal services, listed by codes under spine surgery and large joint services, for some Blue Cross and Blue Shield of Montana Medicare Advantage members. 

What's not changing?

These care categories that require preauthorization for BCBSMT Medicare Advantage members with eviCore Healthcare will stay the same:

  • Advanced imaging
  • Radiation therapy
  • Genetic testing

Why it matters

If benefit preauthorization is required, services performed without benefit preauthorization may be denied for payment and the rendering provider may not seek reimbursement from the member.

Learn more about preauthorization with BCBSMT on our website, including code lists for the services that require preauthorization. Remember code lists are updated periodically.

Always check eligibility and benefits first to confirm membership, coverage, determine if you are in-network for the member's policy and whether preauthorization is required through our Availity® system or your preferred vendor. This step will help you confirm coverage and other important details, such as preauthorization requirements and delegated vendors, if applicable.

Which members and services need preauthorization?

Use Availity® or your preferred vendor to:

  • Check eligibility and benefits
  • Determine if you're in-network for your patient
  • Find out if the patient and services require preauthorization
  • Learn whether preauthorization is required for a specific procedure code

Contact evicore Authorization Client Services at 855-252-1117 or email clientservices@evicore.com for more information.

eviCore is a trademark of eviCore healthcare, LLC, formerly known as CareCore, an independent company that provides utilization review for select health care services on behalf of BCBSMT.

Availity is a trademark of Availity, L.L.C., a separate company that operates a health information network to provide electronic information exchange services to medical professionals. Availity provides administrative services to BCBSMT.

Blue Cross and Blue Shield of Montana, a Division of Health Care Service Corporation, a Mutual Legal Reserve Company, an Independent Licensee of the Blue Cross and Blue Shield Association