How to Complete and Submit the BCBS of Montana Prior Authorization Form

The BCBS Montana prior authorization form you need depends on the service being requested. Blue Cross and Blue Shield of Montana does not publish a single all-purpose form; instead, the provider portal hosts several versions, and choosing the wrong one delays the review. For most medical services, the Recommended Clinical Review Form is the right choice. Inpatient admissions use the Certification for Admission Form. Healthy Montana Kids members have their own form, wheelchairs have a dedicated form, and prescription drug authorizations run through the CoverMyMeds electronic portal rather than a PDF.¹

Which Form Matches Your Service

All of the PDFs below live on the BCBSMT provider portal under “Forms and Documents.”

The Recommended Clinical Review Form is the general-purpose form. Use it for most services, including durable medical equipment, prosthetics, and orthopedic devices. BCBSMT uses this form to make coverage decisions based on medical policy and the member’s contract.
The Certification for Admission Form is built for inpatient hospital admissions and captures the data needed to pre-authorize medical and surgical stays.
The Healthy Montana Kids (HMK) General Form is used exclusively for predetermination requests involving HMK members.
The Wheelchair Medical Necessity/Home Evaluation Form is required when requesting wheelchairs and wheelchair accessories.
For prescription drugs, submit through the CoverMyMeds platform. There is no paper form for pharmacy prior authorizations.¹

Before filling anything out, confirm the service actually requires authorization. BCBSMT keeps separate code lists for commercial plans, Medicare Advantage, and Healthy Montana Kids, and updates them quarterly. A service that did not need authorization last year may need it now. The digital lookup tool on the BCBSMT website lets you check a procedure or drug code directly, and it works for fully insured plans.²

What Every Form Asks For

The forms differ in format, but the required information is largely the same. Get any field wrong and the request stalls.

Patient Information

Enter the patient’s full legal name, date of birth, and BCBSMT Member ID number. The ID begins with a three-character alpha prefix (for example, YDB or BXB) followed by the numeric identifier. That prefix tells BCBSMT which line of business the member belongs to, so leaving it off can route the request to the wrong department.³

Provider Information

The provider section needs the treating physician’s name, National Provider Identifier (NPI), tax identification number, and contact information. These fields establish who is requesting the service and where BCBSMT sends any follow-up questions.

Clinical Information

The clinical section is where most requests succeed or fail. Include:

ICD-10 diagnosis codes documenting the patient’s condition.
CPT or HCPCS procedure codes identifying the exact service being requested.
A clinical justification explaining why this treatment is necessary for this patient, not just medically reasonable in general.
Supporting documentation: recent physician notes, lab results, imaging reports, or records of prior treatments that failed. These give the medical director reviewing the request something to measure against BCBSMT’s published medical policies.

BCBSMT publishes its clinical practice guidelines and medical necessity criteria on the provider portal under “Clinical Resources.”⁴ Reading them before you write the justification helps you frame the request in the terms the reviewer is actually looking for. If the criteria say the patient must try two conservative treatments before imaging is approved, document those failed treatments explicitly.

An incomplete submission gets “pended.” The insurer pauses the review clock and asks for more information, which can add days or weeks. Double-check every field and attach all supporting records before you submit.

How to Submit

Electronic submission through the Availity Essentials portal is the fastest route and the one BCBSMT encourages. If you do not have an Availity account, register at Availity’s website or call Availity Client Services at 800-282-4548. Behavioral health authorizations go through the BlueApprovR tool, which is integrated into Availity’s authorization workflow.⁵

Fax numbers depend on the member’s plan:

Pharmacy prior authorizations go through CoverMyMeds electronically rather than by fax.¹

Electronic submissions generate an immediate confirmation receipt with a tracking number. Save it. That number is your proof of timely filing if a dispute arises later about when BCBSMT received the request.

When You Have to File the Form Yourself

In-network providers handle prior authorization on the patient’s behalf. Out-of-network care flips that responsibility onto the member. If you hold a POS or PPO plan and choose to see an out-of-network provider, you are the one who has to request authorization.⁷

Call the member services number on the back of your ID card and have the following ready:

Your name, subscriber ID number, and date of birth
The provider’s name, address, and NPI
Information about your medical or behavioral health condition
The proposed treatment plan, including any diagnosis or procedure codes
When and where you will receive care, plus an estimated length of stay if you are being admitted⁷

Skipping this step for out-of-network care is one of the most common reasons members get stuck with unexpected bills. Without authorization, BCBSMT can deny the claim entirely and leave you liable for the full cost.

How Long BCBSMT Has to Respond

Montana law, not BCBSMT policy, sets the deadlines. For standard prospective reviews, the insurer must issue a decision within 7 business days of receiving the request, or within 7 business days after receiving all necessary information, whichever applies. If circumstances beyond the insurer’s control require more time, it may extend the deadline once for another 7 business days, but only if it notifies the covered person before the initial window expires.⁸

When waiting would endanger the patient, the provider can request an expedited review. Under MCA 33-32-212, the insurer must respond within 48 hours of receiving the urgent request, as long as enough information has been submitted to make a determination.⁹

The decision, whether approved, denied, or partially approved, comes in a formal determination letter to both the provider and the member. A denial letter must explain the clinical reasons and describe how to appeal.¹⁰ Keep every letter.

If the Request Is Denied

The denial notice includes the appeals process, and the treating doctor receives a separate notice with the option to schedule a phone call with the reviewing clinician.¹¹ That peer-to-peer conversation is often the fastest way to reverse a denial, because the treating physician can present clinical context that did not come through on paper.

If the peer-to-peer call does not resolve it, you can file a formal internal grievance with BCBSMT. Montana law requires every health insurer to maintain written grievance procedures and provide them in the member’s benefit booklet.¹² The forms, deadlines, and mailing address are in your plan documents and repeated in the denial letter.

If BCBSMT upholds the denial through its internal process, you have 120 days from the final adverse determination to request an independent external review. The reviewer, a third-party organization with no ties to the insurer, must issue a written decision within 45 days of receiving the request.¹³ If BCBSMT decides your request is ineligible for external review, you can appeal that ineligibility to the Montana Commissioner of Securities and Insurance, whose contact information must appear in your plan’s grievance documents.¹²

1
Blue Cross and Blue Shield of Montana. Forms and Documents
2
Blue Cross and Blue Shield of Montana. Prior Authorization Lists
3
Blue Cross and Blue Shield of Montana. Three-Character Prefix Guide
4
Blue Cross and Blue Shield of Montana. Medical Policy
5
Blue Cross and Blue Shield of Montana. Provider Tools
6
Blue Cross and Blue Shield of Montana. How to Request Prior Authorization and Recommended Clinical Review
7
Blue Cross and Blue Shield of Montana. Prior Authorization
8
Montana Code Annotated. Montana Code 33-32-211 – Procedures for Standard Utilization Review and Benefit Determinations
9
Montana State Legislature. Montana Code 33-32-212 – Procedures for Expedited Utilization Review and Benefit Determinations
10
Blue Cross and Blue Shield of Montana. Prior Authorization – What You Need to Know
11
Blue Cross and Blue Shield of Montana. What to Do if Your Claim Is Not Approved
12
Montana State Legislature. Montana Code 33-32-307 – Grievance Review Procedures
13
Montana Code Annotated. Montana Code 33-32-410 – Standard External Review