Coding and Compensation Policies are based on criteria developed by specialized professional societies and national guidelines (e.g., MCG). Additional sources are used and can be provided upon request. The Coding and Compensation Policies are not intended to provide billing or coding advice but to serve as a reference for facilities and providers.
Certain policies may not be applicable to self-funded members and certain insured products. Refer to the member's coverage contract or guide to determine whether coverage is provided or if there are any exclusions or benefit limitations applicable to any of these policies. If there is a difference between any policy and the member’s coverage contract or guide, the coverage contract or guide will govern.
In the event of conflict between a Coding and Compensation Policy and any plan document under which a member is entitled to Covered Services, the plan document will govern. Plan documents include but are not limited to: Certificates of Health Care Benefits, benefit booklets, Summary Plan Descriptions and other coverage documents.
In the event of conflict between a Coding and Compensation Policy and any provider contract pursuant to which a provider participates in and/or provides services to eligible members and/or plans, the provider contract will govern.
Current Coding and Compensation Policies are accessible in Availity® Essentials by using the Plan Documents Viewer application in the payer spaces for Blue Cross and Blue Shield of Montana.
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.