July 3, 2024
The IVR phone system was recently enhanced with a new menu option to allow you to confirm prior authorization requirements for procedure code(s) without having to first check the patient’s eligibility and benefits. This new feature will save you time and assist with obtaining necessary information and/or requirements without having to speak with a Customer Advocate.
A new Check Authorization by Procedure Code Caller Guide that includes instructional assistance is coming soon to the Interactive Voice Response System page on our Provider website.
As a reminder, you can always check prior authorization requirements for procedure codes by using Availity® Essentials Eligibility and Benefits Inquiry for our members.
Need IVR Assistance? Email our Provider Education Consultants.
This information does not apply to Medicare Advantage.
Checking eligibility and/or benefit information and/or obtaining prior authorization is not a guarantee of payment. Benefits will be determined once a claim is received and will be based upon, among other things, the member’s eligibility and the terms of the member’s certificate of coverage, including, but not limited to, exclusions and limitations applicable on the date services were rendered. Certain employer groups may require prior authorization or pre-notification through other vendors. If you have any questions, call the number on the member's ID card. Regardless of any prior authorization or benefit determination, the final decision regarding any treatment or service is between the patient and the health care provider.
Availity is a trademark of Availity, LLC, a separate company that operates a health information network to provide electronic information exchange services to medical professionals. Availity provides administrative services to BCBSMT. BCBSMT makes no endorsement, representations or warranties regarding third party vendors and the products and services they offer.