Blue Review

Blue Cross Blue Shield of Montana
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Blue Review

For Providers

August 2026

 

AUGUST SPOTLIGHT

Watch for Behavioral Health Provider Satisfaction Survey

You’ll be contacted by email or mail if selected to participate. The survey measures your satisfaction with us and identifies areas where we can improve.

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CLAIMS AND ELIGIBILITY

Review Changes to Anesthesia Rates for Commercial Plans

As of Aug. 1, 2026, we updated the anesthesia conversion factors for commercial plans.

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See Prior Authorization Changes for Some Commercial and Government Program Members

We’ve updated prior authorization requirements for some commercial and government plans to reflect new, replaced or removed codes.

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Take Note of Change in Recommended Clinical Review Request Process

Effective Aug. 15, 2026, we’re retiring the recommended clinical review request process through the Availity® Essentials Attachments tool. You may continue to submit requests online through Availity Authorizations and by fax and phone.

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CLINICAL RESOURCES

Encourage Routine Vaccines and Well‑Care Visits for Children and Adolescents

We track quality measures on immunizations for adolescents and preventive care visits for members ages 3 to 21. See tips to close care gaps.

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Avoid Antibiotics for Acute Bronchitis and Other Viruses

With back‑to‑school season approaching, consider talking with our members about taking antibiotics only when needed. See alternatives to antibiotics and information to share.

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Discuss Preventive Care With Members

To reduce the risk of problems or catch them early, consider encouraging our members to seek preventive care, when appropriate. Review tips and preventive care guidelines.

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EDUCATION

Explore Learning Opportunities

We offer free training for providers who participate in our networks. View and sign up for sessions.

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NETWORK PARTICIPATION

Review PEAQSM Methodology Updates for 2026

The updated methodology for our Provider Efficiency, Appropriateness, & QualitySM program is now available. This methodology explains how PEAQ evaluates provider performance.

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Provisional Credentialing Discontinued for Professional Providers

As of July 1, 2026, we discontinued provisional credentialing for professional providers to streamline our credentialing processes.

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PHARMACY

Review Pharmacy Program Quarterly Updates – Part 2

We’ve made changes to our drug lists and utilization management program. Learn about these and other pharmacy program updates.

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STANDARDS AND REQUIREMENTS

Learn About Updates to Reimbursement Policies

We regularly add and modify reimbursement policies, formerly known as coding and compensation policies, as part of our ongoing policy review. See which policies were updated.

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Review Active and Pending Medical Policies

Approved new or revised medical policies and their effective dates are usually posted on our website the first and 15th of each month. 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.

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Stay Informed

Watch News and Updates and this newsletter for the latest information. If someone in your practice would like to receive Blue Review, share this link to subscribe.

Our provider website has information about training, online tools and other resources.

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Verify Your Directory Details Every 90 Days

Your directory information must be verified every 90 days. It’s easy and quick to get it done for all health plans in Availity Essentials leaving site icon, or you can use our Demographic Change Form. Learn more.

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Contact Us

Contact information for Network Representatives and other resources is on our website.

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bcbsmt.com/provider
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