Claims and Eligibility
Standards and Requirements
Finding the right contact may save you time. Sometimes it's easy to know where to go for assistance. At other times, it's less clear. Use the drop down menus below to help guide you to the best point of contact for your answer.
You may also use the Provider Contact Reference Guide.
Blue Cross Blue Shield of Montana
Attn: Corporate Tax, A-2
PO Box 655730
Dallas, TX 75265
Phone: 972-766-9057
Fax: 972-766-6657
To request a duplicate 1099, you must include the following information:
To request a corrected 1099, you much include the following information:
Contact based on member policy:
| Group & Individual Appeals | Non-Emergent Fax: 866-589-8256 Emergent Fax: 406-441-5569 |
| Healthy Montana Kids Appeals | Non-Emergent Fax: 866-589-8256 Emergent Fax: 406-441-5569 |
| Medicare Advantage Claim Disputes | Blue Cross Medicare AdvantageSM Attn: Claims Disputes P.O. Box 4555 Scranton, PA 18505 Fax: 855-674-9192 |
| Medicare Advantage Clinical Appeals | Blue Cross Medicare AdvantageSM Attn: Appeals Department P.O. Box 663099 Dallas, TX 75266 Standard Appeals Fax: 800-419-2009 Expedited Appeals Fax: 800-338-2227 |
Professional, Group, & Clinic Providers: Please fill out and submit the Provider OnBoarding Form.
Ancillary & Facility Providers: Please fill out and submit the Facility/Ancillary Participation Form.
See the How to Join page for more information.
Please fill out and submit the Demographic Change form to change any of the following:
Professional Providers may also update their information in Availity® Essentials. Anciliary and Facility Providers should continue to use the form above.
Dental Benefits Customer Service: 888-381-9727 (Monday through Friday, 7 a.m. to 6 p.m. MST.)
Verify eligibility and benefits and/or check claim status for FEP® members.
EHB: 800-442-4607
PSHB: 877-707-2786
FEP® behavioral health services: 800-528-7264
Report concerns of potential fraud 24x7, online or by phone. All inquiries to our Special Investigations Department are confidential, and you may remain anonymous.
Call the Fraud Hotline: 800-543-0867
| Healthy Montana Kids | 855-258-3489 |
| FEP Prior Authorization | P: 877-885-3751 |
| Case Management | P: 855-313-8908 |
| Disease Management | P: 866-412-8795 |
| HMK Recommended Clinical Review & Prior Authorization | P: 855-699-9907 F: 855-610-5684 |
| BH Prior Authorization | P: 855-313-8909 F: 855-649-9681 |
| Individual Plans Medical Prior Authorization | P: 855-458-9444 |
| Group Plans Prior Authorization | P: 855-313-8914 F: 866-589-8256 |
| Recommended Clinical Review | P: 800-447-7828 F: 866-900-2634 |
| MA Prior Authorization | P: 877-774-8592 |
| Medicare Advantage Individual | 877-774-8592 |
| Medicare Advantage Group | 877-299-1008 |
| Medicare Advantage Peer to Peer Scheduling | 800-981-2795 |
| Individual plan phone | 877-774-8592 |
| Group plan phone | 877-299-1008 |
| Electronic claims (preferred) | Availity® Essentials or your preferred vendor Electronic payer ID 66006 |
| Paper claims | Blue Cross Medicare Advantage c/o Provider Services PO Box 3686 Scranton, PA 18505 |
| Register with Availity at no cost to conduct secure online transactions, such as checking eligibility and benefits, submitting prior authorization requests handled by Blue Cross and Blue Shield of Illinois, obtaining claim status, viewing provider claim summaries and more. | Learn more, register or log on: Availity Essentials Availity Client Services: 800-282-4548 |
Who can request a medical appeal: Member, member's authorized representative, contracted providers or noncontracted providers
| Standard appeals fax | 1-800-419-2009 |
| Expedited appeals fax | 1-800-338-2227 |
| Mailing address | Blue Cross Medicare Advantage c/o Appeals Department PO Box 663099 Dallas, TX 7526 |
Who can request a retrospective medical appeal: Member, member's authorized representative or noncontracted providers
| Standard appeals fax | 1-800-419-2009 |
| Mailing address | Blue Cross Medicare Advantage c/o Appeals Department PO Box 663099 Dallas, TX 75266 |
Who can request a provider dispute: contracted providers
| Standard claims dispute fax | 1-855-674-9192 |
Mailing address | Blue Cross Medicare Advantage c/o Provider Disputes PO Box 4555 Scranton, PA 18505 |
Who can request a provider claims dispute: Contracted and noncontracted providers
| Standard claims dispute fax | 1-855-674-9192 |
| Mailing address | Blue Cross Medicare Advantage Attn: Provider Claims Disputes PO Box 4555 Scranton, PA 18505 |
Who can file a grievance: Member or member’s authorized representative
| Grievance fax | 1-855-674-9189 |
| Mailing address | Blue Cross Medicare Advantage Attn: Grievances PO Box 4288 Scranton, PA 18505 |
| Availity Authorizations & Referrals | Electronically submit prior authorization requests |
| Prior authorization requirements for Medicare Advantage | |
| EviCore healthcare prior authorization | |
| Prior authorization and out-of-network referrals | Phone: 877-774-8592 Fax: 855-874-4711 |
Email: hcsx6100@bcbsmt.com
Leave a message. We will respond within 48 hours.
| As our pharmacy benefit manager, Prime Therapeutics® administers our pharmacy program for eligible members. | View pharmacy programs information |
Provider Customer Service
| If you don’t have online access, call our Provider Telecommunications Center to use our automated phone system for eligibility and benefits, other self-service requests and claims inquiries. | 800-972-8088 (Monday through Friday, 8 a.m. to 11:30 p.m. CT; and Saturday, 6 a.m. to 3:30 p.m. CT) |
Provider Customer Service – Government Programs
| Use these numbers for claims and other inquiries for our members with Blue Cross Medicare AdvantageSM and Medicaid plans. | Medicare Advantage (PPO and HMO): 877-774-8592 |
Claim Status or Routine Inquiry: 866-651-4977
Provider’s Zip Code will route to WPS for Legacy Region and TriWest for Expansion Region
mt_ valuebasedcareteam@bcbsmt.com
Checking eligibility and benefits and/or obtaining prior authorization is not a guarantee of payment of benefits. Payment of benefits is subject to several factors, including, but not limited to, eligibility at the time of service, payment of premiums/contributions, amounts allowable for services, supporting medical documentation, and other terms, conditions, limitations, and exclusions set forth in the member’s policy certificate and/or benefits booklet and or summary plan description. Regardless of any prior authorization or benefit determination, the final decision regarding any treatment or service is between the patient and their health care provider.
Availity is a trademark of Availity, LLC, an independent company that operates a health information network to facilitate electronic information exchange for healthcare professionals. Carelon Medical Benefits Management is an independent company that has contracted with BCBSMT to provide utilization management services for members with coverage through BCBSMT. Evicore healthcare (Evicore) is an independent company that has contracted with BCBSMT to provide prior authorization for expanded outpatient and specialty utilization management for members with coverage through BCBSMT. Prime Therapeutics LLC (Prime) is a pharmacy benefit management company. BCBSMT contracts with Prime to provide pharmacy benefit management and other related services. BCBSMT, as well as several independent Blue Cross and Blue Shield Plans, has an ownership interest in Prime. BCBSMT makes no endorsement, representations or warranties regarding third party vendors and the products or services they offer.