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Medicaid Pharmacy Program Introduces Electronic Prior Authorization

December 26, 2013

Blue Cross and Blue Shield of New Mexico (BCBSNM) has enhanced the process for submitting Prior Authorization (PA) requests for drugs that are part of our Medicaid PA program.

Previously, the only option was to download and print a PA form, complete it by hand and submit it via fax. With this process, providers had no confirmation upon receipt, often causing needless resubmission. Additionally, the fax request process typically resulted in phone calls to providers regarding deletion of duplicate requests, member ineligibility, missing or illegible information.

We’re pleased to announce an alternative to faxed PA requests. Now, when you visit our website at bcbsnm.com/provider, you’ll find a new electronic prior authorization link in the Network Participation/Medicaid section, under Rx Drugs. This link takes you to the log-in page for CoverMyMeds®, an online tool that allows electronic completion and submission of Medicaid PA requests. A link to CoverMyMeds is also available on the HealthXnet® portal.

Electronic PA requests have many advantages, including:

  • Immediate confirmation upon receipt
  • No need to resubmit or call to check status
  • Connects the pharmacy with the physician


Here’s how it works:

From the CoverMyMeds log-in page, new users can select Create an Account to sign up and create a password. CoverMyMeds will confirm that you are a BCBSNM Medicaid contracted provider prior to granting access. If there are any questions, a live chat feature is available. There is no cost to use CoverMyMeds.

When a request is initiated, CoverMyMeds will first check eligibility to ensure that the patient is a BCBSNM member. After you submit your request, you’ll receive an immediate confirmation with details on when the determination will occur. Upon approval, you’ll receive an electronic notification from CoverMyMeds.

Additional enhancements will be announced in the coming months. Watch for more details in the Blue Review and News and Updates section of our Provider website.

 

CoverMyMeds is a registered trademark of CoverMyMeds LLC, an independent third party vendor that is solely responsible for its products and services. BCBSNM makes no endorsement, representations or warranties regarding any products or services offered by independent third party vendors. If you have any questions regarding the products or services they offer, you should contact the vendor(s) directly.

HealthXnet is a registered trademark of Healthcare Extranets LLC.  All rights reserved


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