Training Opportunities

BCBSMT: Availity® Provider Training

In these one-hour webinar sessions, we will present an overview of electronic options available in the Availity Engagement Portal for BCBSMT providers.

Participants will learn how:

  • Check real-time eligibility and benefits
  • Conduct pre-service request
  • Utilize the Availity Claim Research Tool for enhanced claim status
  • Complete post-service reconciliation
  • Enroll for electronic remittance and fund transfer

New and existing Availity users are highly encouraged to attend. To register for a complimentary webinar, select a session date & time below.

Join us for an Online Clinical Data Exchange for Quality and Risk Adjustment webinar:

Use the links below to register for sessions covering the Medical Attachments, CQV and CERA tools. Select a session date and time:

Learn More:

Medical Attachments for Quality and Risk Adjustment Purposes
You can now receive and respond to quality and risk adjustment medical record requests electronically via Availity’s Medical Attachments tool. Learn more about Electronic Quality and Risk Adjustment Medical Records Requests.

Clinical Quality Validation (CQV) Tool
Comply with Healthcare Effectiveness Data and Information Set (HEDIS®) measures using Availity’s new Clinical Quality Validation Tool. By using CQV you may document your patients’ care and assessments electronically, while closing quality HEDIS gaps. CQV also helps support the Centers for Medicare & Medicaid (CMS) STAR rating for Blue Cross Medicare Advantage (HMO)SM and Blue Cross Medicare Advantage (PPO)SM plans. Learn more about CQV.

Claim Encounter Reconciliation Application (CERA)
CERA helps you respond to BCBSTX if potential risk adjustment gaps are identified based on claims data for members with commercial and on/off-exchange health plans. Learn more about CERA.

Availity users have access to many other tools and resources. Visit the BCBSMT provider website to learn more about online options. Providers who are not Availity users are encouraged to register with Availity.com and complete the online application, at no charge.

At this time, electronic medical record request and submission process are not available for medical record requests resulting from utilization review activities or the claims adjudication process.

Remittance Viewer

This online Availity tools offers providers and billing services a convenient way to view claim detail information from the 835 Electronic Remittance Advice (835 ERA). Attend a webinar to learn how to gain or grant access, conduct a search, view general and payer specific information, and save or print results.

To register, select a webinar date and time from the list below:

iExchange

iExchange is an electronic tool that supports the submission and online approval of benefits for inpatient and select outpatient preauthorization and predetermination requests. To register for a New Enrollee Training session, select a webinar date and time listed below:

Verifying Procedure Code Preauthorization Requirements Online

BCBSMT invites you to join a complimentary webinar training to learn how to successfully verify code-specific preauthorization requirements for benefits and procedure codes through the eligibility and benefits inquiry via the Availity® Provider Portal. To register for a session, select a date and time below.

Providers who render the following services are encouraged to register for an upcoming webinar session:

  • Advanced Imaging
  • Expanded Specialty Pharmaceuticals

The CPT/HCPCS code inquiry option is for preauthorization determination only and is not a code-specific quote of benefits. Checking eligibility and/or benefit information and/or the fact that a service has been preauthorized is not a guarantee of payment.

Online CPT/HCPCS code inquiry for preauthorization is not returned for the following BCBSMT members:

  • Federal Employee Program® (FEP® )
  • Blue Cross Medicare Advantage (PPO)SM

Checking eligibility and/or benefit information and/or the fact that a service has been preauthorized 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 or contract of coverage applicable on the date services were rendered. If you have any questions, please call the number on the member’s ID card.

CPT copyright 2018 American Medical Association (AMA). All rights reserved. CPT is a registered trademark of the AMA.

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 independent 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.