Patient Cost Estimator via Availity® Essentials is a member liability estimator that can help professional and institutional providers estimate our members’ potential out-of-pocket costs in real time for services provided.
PCE is available at no cost to providers contracted with us and registered with Availity Essentials.
How does PCE determine an estimate?
- It analyzes the member’s primary diagnosis, procedures performed, available benefits and contractual allowances to calculate an estimate based on the information available at the time the estimate was processed.
- Actual coverage and member liability amounts are determined when the claim is processed.
PCE allows you the option of collecting the member’s share at the point of service. You may not collect an amount greater than the amount listed by the PCE at the time services are rendered. Any overpayments must be refunded to the member within 30 days.
For more details, including a brief list of exceptions, refer to the Availity Patient Cost Estimator User Guide.
To register with Availity, gain access to PCE and learn about other options, visit Availity or call Availity Client Services at 800-282-4548 for assistance.
Benefits will be determined once a claim is received by BCBSMT and will be based upon, among other things, the member’s eligibility, benefits, limitations and exclusions and the terms of the member’s certificate of coverage in effect on the date services are rendered.
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.