Quality Measures Help Track Our Members’ Heart Health

Heart disease and stroke are among the leading causes of death in the U.S. We track measures related to our members’ blood pressure control and statin therapy. Learn steps to help identify and close care gaps.

Avoid Inappropriate Use of Antipsychotic Medication for Anxiety Disorders

Most antipsychotic medications aren’t approved for the treatment of anxiety disorders. We encourage prescribing providers to carefully assess symptoms, risks and benefits when considering medications for our members with anxiety disorders.

Postponed: Updates to Behavioral Health Substance Use Criteria for Utilization Management

We’ll continue to apply criteria from the American Society of Addiction Medicine’s third edition in our medical necessity reviews for substance use services for adults and adolescents.

Confirm Your Medical Records Align with Submitted Claims

Maintaining complete, accurate records and claims is a contractual requirement. It can help ensure accurate payment for services you provide to our members.

Earn Continuing Education Credit in Courses on Maternal Mental Health

You can access March of Dimes^® e‑learning modules on maternal mental health and perinatal loss at no cost through May 13, 2025.

Reduce Barriers to Care for Indigenous Montanans

Hear from Tribal members about culturally appropriate care in training offered by Montana’s Tribes and health care agencies.

Big Sky Pulmonary Conference Set for March 6‑7, 2025

This annual event highlights methods to combat respiratory disease and associated risk factors.

Annual Survey Monitors Our Members’ Health Care Experiences

Every year, some of our Medicare Advantage members receive the Consumer Assessment of Healthcare Providers and Systems survey. It asks them to rate their experiences with their health care providers and plans. Learn about survey topics our members may discuss with you.

Patients in the Qualified Medicare Beneficiary Program Should Not Be Billed

QMB patients are eligible for both Medicare and Medicaid. If you participate in Blue Cross Medicare Advantage^SM, you may not bill our members enrolled in the QMB program. Learn precautions to take to avoid billing these members.

Hospitals Must Provide Notice to Members Under Outpatient Observation for More Than 24 Hours

Hospitals and critical access hospitals are required to give the standardized Medicare Outpatient Observation Notice to Medicare Advantage plan members who are under outpatient observation for more than 24 hours. The notice explains why the members aren’t inpatient and their cost‑sharing obligations.

Pharmacy Program Quarterly Update – Part 2

Some changes were made to our drug lists and utilization management program. Learn about these and other pharmacy program updates.

Laboratory Management Payment and Coding Policies Updated

We’ve updated multiple Laboratory Management policies with a new code released by the American Medical Association, effective Jan. 1, 2025.

Coding and Compensation Policy Updates

You can access new or revised clinical payment and coding policies in Availity^® Essentials through the Plan Documents Viewer application, in the category Coding and Compensation Policies. These policies provide billing, coding and documentation guidelines. Visit Availity regularly to ensure you’re up to date on any changes or new policies.

Medical Policy Updates

Approved new or revised medical policies and their effective dates are usually posted on our website the first and 15th of each month under the Standards and Requirements tab. You can view all active and pending policies, as well as draft medical policies, and provide comments on draft policies. These policies may impact your reimbursement and your patients’ benefits.