The Montana Psychiatric Association and Montana Association of Pediatric Psychiatrists filed complaints with the state over Blue Cross and Blue Shield of Montana’s reimbursement practices, NPR affiliate Montana Public Radio reported Aug. 24.
The complaints allege Blue Cross is downcoding nearly all visits to the lowest level without reviewing medical documentation showing more complex care was provided.
The Montana Commissioner of Securities and Insurance said it is “engaging with Blue Cross on the matter.” The agency regulates the industry.
Blue Cross said it changed how it evaluates what medical providers bill for to “ensure claims are submitted with accurate and complete information.” The insurer said its policy complies with state and federal law.
Psychiatrist Julian Thorne, MD, who sits on the Montana Psychiatric Association’s board, said the reimbursement practice could result in shorter patient visits. He also said providers may stop accepting Blue Cross or insurance altogether, reducing patients’ choices.
Blue Cross and Blue Shield of Montana said in a statement shared with Becker’s:
“Blue Cross and Blue Shield of Montana is committed to expanding access to quality health care to people in every stage of their lives.
“As of July 1, 2026, BCBSMT conducts post-service, pre-pay reviews of professional evaluation and management (E/M) claims to ensure claims are submitted with accurate and complete information, all in accordance with the current version of the American Medical Association (AMA) CPT codebook and applicable CMS coding criteria.
“Our enhanced claims review process does not ‘automatically downcode’ claims or use artificial intelligence to make decisions regarding E/M levels in claims. Instead, our process is well designed and intended to appropriately support accurate payments of correctly coded claims for the level of service reflected in the claim.”
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