All PlansAdministrativeLow impact
Provider Rights and Responsibilities
BCBS Montana·MT·General
Effective date
Jun 11, 2026
We identified it
Jun 18, 2026
Summary
This policy outlines provider rights and responsibilities for credentialing, case management programs, and utilization management decisions. It clarifies that licensed clinical personnel make all utilization management decisions based on medical necessity and coverage, not financial incentives.
Action Required
No immediate action required. This is informational guidance about existing provider rights and responsibilities. Billing teams should be aware that utilization management decisions are made by licensed clinical personnel based on medical necessity criteria, and providers can call the member ID card number to obtain criteria used for these decisions.