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For Providers
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May 2026 |
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MAY SPOTLIGHT |
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Reinforce Prenatal and Postpartum Care To Support Whole Health
We track quality measures related to our members’ care visits and depression screening during and after pregnancy. Review tips to close gaps in care.
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BEHAVIORAL HEALTH |
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See Our Behavioral Health Resources for Providers
Resources for providers across disciplines include clinical practice guidelines and information on quality measures, as well as introductory webinars offering continuing education credit at no cost to you.
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CLAIMS AND ELIGIBILITY |
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See Prior Authorization Changes for Some Commercial and Government Program Members
We’ve updated prior authorization requirements for certain commercial and government plans to reflect new, replaced or removed codes.
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Watch for Claim Editing Changes for Evaluation and Management Services for Commercial Members
Effective July 1, 2026, we’ll enhance our claims editing and review process for office, inpatient and outpatient evaluation and management services for our members with commercial plans.
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Two New Claims Editing Rules To Be Implemented in July 2026
On or after July 8, 2026, we’ll update the Lyric software database to better align provider coding with industry standards for accurate billing and proper reimbursement.
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EDUCATION |
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Explore Learning Opportunities
We offer free training for providers who participate in our networks. View and sign up for training sessions, including a new course on youth behavioral health.
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MEDICARE |
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Use Updated Hospital Forms for Medicare Members
The Centers for Medicare & Medicaid Services updated its Important Message from Medicare and Detailed Notice of Discharge. Learn how to access the forms.
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NETWORK PARTICIPATION |
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See Information on Fee Schedule and Compensation Policy
Our biennial fee schedule updates typically occur on June 1. Learn about the adjusted schedule for 2026.
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PHARMACY |
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Review Pharmacy Program Quarterly Update – Part 2
Changes were made to our drug lists and utilization management program. Learn about these and other pharmacy program updates.
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STANDARDS AND REQUIREMENTS |
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Learn About Updates to Coding and Compensation Policies
We regularly add and modify 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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Contact Us
Contact information for Network Representatives and other resources is on our website.
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Blue Cross and Blue Shield of Montana, a Division of Health Care Service Corporation,
a Mutual Legal Reserve Company, an Independent Licensee of the Blue Cross and Blue Shield Association
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3645 Alice St., Helena, MT 59601
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