Medicare Advantage — Discontinued Authorization Requirements through eviCore Healthcare

Preauthorization (PA) is no longer required for certain services rendered on and after April 1, 2018. This does not apply to services rendered prior to April 1, 2018. While a PA is no longer required, services are still subject to Medical Necessity and coverage criteria for payment. Blue Cross and Blue Shield of Montana (BCBSMT) may conduct post-service claim review for the appropriateness of care.

eviCore will discontinue all PA and retrospective Utilization Management (UM) services requested by providers for the medical services identified below.

Discontinued Preauthorization Requirement for These Services

       Service Modality

• Ultrasound
• Physical Therapy
• Occupational Therapy
• Speech Therapy
• Chiropractic
• Pain Management
• Sleep Therapy
• Sleep DME

Membership Impacted

• Montana Individual Medicare HMO
• Montana Individual Medicare PPO
• Montana Group Medicare PPO

Please refer to the BCBSMT Medicare Advantage Discontinued Code List