Provider Tools

These complimentary online applications can be used to accomplish tasks and gain information. Some of the tools require registration through a third-party vendor portal, as noted — see our E-Commerce Connections menu for vendor registration details.

Availity Eligibility and Benefits

It is important to verify membership and check coverage details for every patient at every visit, before you administer treatment.

To obtain fast, efficient, detailed benefits information for Blue Cross and Blue Shield members, you can use Availity's Eligibility and Benefits tool. This free online tool can provide you with co-payment, co-insurance, deductible, and other important information.

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Responding to Quality and Risk Adjustment Medical Record Requests Online via AvailityTM Provider Portal

The AvailityTM Medical Attachment tool allows providers to receive electronic quality and risk adjustment medical record requests from BCBSMT. Providers can upload and submit the necessary medical records to BCBSMT using the Medical Attachment option in the Claims & Payments menu through the Availity Provider Portal.

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Claim Encounter Reconciliation Application (CERA) via Availity® Provider Portal

The Availity Claims Encounter Reconciliation Application (CERA) helps providers manage and respond to BCBSMT if potential coding opportunities are identified -- based on claims data -- for members with on and off-exchange health plans. Providers may upload and submit the necessary medical documentation to BCBSMT using CERA in the Claims & Payments menu through the Availity Portal.

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Clinical Quality Validation (CQV) Application

Clinical Quality Validation (CQV) is a web-based application in the Availity® Provider Portal that allows providers to quickly comply with Healthcare Effectiveness Data and Information Set (HEDIS®) measures. Providers can electronically document their patient’s care and assessments to close quality HEDIS care gaps for BCBSMT members using CQV.

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Behavioral Health Eligibility and Benefits

Behavioral health professionals and physicians may obtain benefits information for Blue Cross and Blue Shield members using the AvailityTM Eligibility and Benefits (E&B) tool. This free online tool can provide you with copayment, coinsurance, deductible, and other important information.

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Blue Distinction Centers®

Find facilities recognized for expertise in bariatric surgery, cardiac care, complex and rare cancers, knee and hip replacement, spine surgery, and transplants on the Blue Distinction  website.

Claim Inquiry Resolution (CIR) Tool

Our Claim Inquiry Resolution (CIR) tool is available via a tab in our Electronic Refund Management (eRM) system. By providing a method for online assistance with specific inquiries on finalized claims, the CIR tool can help save your staff time by reducing the need for phone calls and written correspondence.

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Claim Research Tool

The Claim Research Tool (CRT) offers enhanced, real-time claim status functionality to help you manage and resolve your BCBSMT claims. To gain access to the CRT, you must be registered with AvailityTM .

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Clear Claim ConnectionTM

Clear Claim Connection (C3) is a free online reference tool that mirrors the logic behind BCBSMT's code-auditing software.* You can use C3 to help determine how coding combinations on a particular claim may be evaluated during the adjudication process.

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CoverMyMeds®

CoverMyMeds is an online tool for electronic completion and submission of benefit prior authorization (PA) requests for prescription drugs that are part of the Blue Cross and Blue Shield of Montana (BCBSMT) pharmacy PA program.

Electronic Refund Management (eRM)

The Electronic Refund Management (eRM) tool is designed to help simplify overpayment reconciliation and related processes. Among other features, the eRM tool provides:

  • Single sign-on convenience
  • Electronic notification of overpayments
  • Online Inquiry/Dispute/Appeal functionality
  • Option to deduct from future payments
  • Pay by check capability

The eRM tool also includes a Claim Inquiry Resolution (CIR) PDF Document function, which enables you to submit a variety of online requests for reconsideration on finalized claims.

Prior to accessing eRM:

  • You must register with AvailityTM or the BCBSMT Secure Provider Portal.
  • For Secure Provider Portal registration information, visit the Electronic Commerce section on our website at bcbsmt.com/provider.
  • For Availity registration information, visit www.availity.com, or call Availity Client Services at 800-AVAILITY (282-4548).

Once you're registered…

  • Log into Availity or the BCBSMT Secure Provider Portal and complete the online onboarding form.
  • BCBSMT Secure Provider Portal users: click on the ERM link.
  • Availity users: click on More from the main menu, and select Refund Management - eRM (BCBS).
    • If you are unable to access this link, contact your Availity Administrator.
  • For assistance or more information, email PECS@bcbsmt.com.

On-Demand Training

An eRM tutorial  is available to show you how to navigate the features of the eRM tool. Log in at your convenience to complete the tutorial and use it as a reference when needed.

iExchange®

Our automated preauthorization tool – AerialTM iExchange® (iExchange) – supports direct submission and provides online approval of benefits for inpatient admissions, as well as select outpatient, and pharmacy services 24 hours a day, seven days a week – with the exception of every third Sunday of the month when the system will be unavailable from 11 a.m. to 3 p.m. (CT). iExchange is accessible to physicians, professional providers and facilities contracted with BCBSMT.

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Patient Care Summary

The Patient Care Summary tool uses claim-based information to provide you with a consolidated view of a patient's health care history at the point of care. This electronic health record can help you identify gaps in care, missed prescription refills and possible drug interactions, and other "clinical flags" and treatment opportunities.

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Remittance Viewer

The remittance viewer offers providers and billing services a convenient way to view and help reconcile claim data provided by (BCBSMT) in the 835 Electronic Remittance Advice (ERA).

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Reporting On-Demand

The AvailityTM Reporting On-Demand application allows users to readily view, download, save and/or print the Provider Claim Summary (PCS) and other reports online, at no additional cost.

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