BlueApprovRSM Now Accepts Recommended Clinical Reviews (Formerly Predeterminations) — Attend a Training 

September 11, 2023

Blue Cross and Blue Shield of Montana (BCBSMT) continues to streamline the pre-service review process to reduce your workload with BlueApprovRSM. This tool, accessible in Availity® Essentials, now processes optional recommended clinical reviews (RCR) (formerly referred to as predeterminations or pre-Authorizations) for some medical and surgical services and specialty pharmacy drugs for many of our commercial members.

Submit Recommended Clinical Review and Prior Authorization Requests through BlueApprovR

  • In Availity, select Payer Spaces from the navigation menu, then BCBSMT
  • On your Payer Spaces page, select the Applications tab and click BlueApprovR
  • Users will be redirected to BlueApprovR to complete requests

Note: your RCR submissions will follow the same path through BlueApprovR as prior authorization requests. Also, your RCR submission via BlueApprovR replaces the need to FAX or to attach forms in Availity.

BlueApprovRSM Offers End-to-End Efficiencies

Registered Availity Essentials users have free, 24/7 access to BlueApprovR to:

  • Request RCR and prior authorization for many services and specialty pharmacy drugs
  • Secure real-time approvals for certain services and drugs and begin treatment right away
  • Easily attach medical records
  • Check approval status of your request

Provider Training

You can attend an instructor-led, free webinar to learn how to use BlueApprovR. To register, select your preferred date and time from the list below. Times listed are Mountain Time:

Use BlueApprovR to Request RCR and Prior Authorization for these types of care

  • Specialty Pharmacy Drugs
  • Inpatient Acute Care
  • Long-term Acute Care
  • Inpatient Rehab
  • Skilled Nursing Facility
  • Outpatient Hospice
  • Inpatient Hospice
  • Home Health
  • Outpatient Service

Other Recommended Clinical Review Request Method

Use the Availity Attachments tool to submit an RCR or download and complete the Recommended Clinical Review (Predetermination) Request Form.

Note: This new tool is currently not available for our Federal Employee Program®, Medicare Advantage or Healthy Montana Kids members. Please use your existing process for requesting RCR for these members.

Provider Resources

Learn more about how to access and use BlueApprovR at our Provider Tools web page. Continue to watch News and Updates for future program updates and training opportunities.

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. If you have any questions, call the number on the member's ID card.

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.