![]() You can also refer to the Electronic Provider Access (EPA) FAQs for additional information. View the Medical Policy and Precertification/Prior Authorization Information for Out-of-Area Members to access the Provider Router. Click the link below to open the tool and simply enter the member's Alpha Prefix (first three letters of the identification number) located on their ID Card to be routed to the appropriate Plan. This tool will route you directly to the other Plan's website to view specific prior authorization/precertification requirements for an out-of-area member. Use our Provider Router to obtain information about prior authorization/precertification for members of other Blues Plans (out-of-area members). ![]() Prior authorization/Precertification Information for BlueCard (Out-of-Area) Members If you have questions about the response, contact Utilization Management or the authorizing vendor. The results are then sent to the provider and member. ![]() Meets the health plan’s definition of “medically necessary.”.Date of service, estimated length of stay (if the patient is being admitted)Īfter the request is submitted, the service or drug is reviewed to determine if it:.Patient’s medical or behavioral health condition.Submit Prior Authorization request via Availity.Services requiring prior authorization for Medicare Advantage: Services requiring prior authorization for Federal Employee Program: Services requiring prior authorization for Healthy Montana Kids through BCBSMT: Refer to the eviCore page for more information.Submit requests via the eviCore Healthcare Web Portal.Services requiring prior authorization through eviCore®: For Technical Support, Call Carelon Medical Benefits Management at 1-80.Submit requests using the Carelon Medical Benefits Management provider portal.Services requiring prior authorization through Carelon Medical Benefits Management (formerly known as AIM Specialty Health) (Jan. Call toll-free at 1-85 or the phone number listed on the member's ID card.To learn more, visit Availity Authorizations & Referrals. Submit via Authorizations & Referrals.Use BlueApprovR SM to request prior authorization for some services ( visit our BlueApprovR Provider Tools Page for instructions).Services requiring prior authorization through BCBSMT: This will determine if prior authorization will be obtained through us or a dedicated vendor. Submitting Prior Authorization Requests Step 1:Ĭonfirm if prior authorization is required using Availity® Essentials or your preferred vendor. The following outlines the process for providers to submit prior authorization requests.
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