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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 commercial PA program. Note: This enhancement does not apply to PA requests for BlueSaludSM members.  Additional information specific to New Mexico Medicaid can be found in the Medicaid Pharmacy Program Introduces Electronic Prior Authorization article.

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, you’ll find a new Electronic Prior Authorization link in the Pharmacy Program/Commercial section, under Prior Authorization and Step Therapy. This link takes you to the log-in page for CoverMyMeds®’, an online tool with a list of BCBSNM pharmacy request forms that can be completed and submitted electronically. Additionally, providers who are registered with Availity® may access CoverMyMeds via the BCBS Pharmacy Prior Authorization link on the Availity portal. 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 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 who has Prime Therapeutics as their pharmacy benefit manager. 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. Likewise, the member’s pharmacy is contacted with the decision and pending claims can then be processed accordingly.

Additional enhancements will be announced in the coming months. Watch for more details in the Blue Review and News and Updates for details.

 

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.

Prime Therapeutics LLC is a pharmacy benefit management company. BCBSNM contracts with Prime to provide pharmacy benefit management, prescription home delivery and specialty pharmacy services. BCBSNM, as well as several other independent Blue Cross and Blue Shield Plans, has an ownership interest in Prime.

Availity is a registered trademark of Availity, LLC. Availity is a partially owned subsidiary of Health Care Service Corporation, a Mutual Legal Reserve Company (HCSC), an independent licensee of the Blue Cross and Blue Shield Association. Availity operates a health information network to provide electronic information exchange services to medical professionals. Availity provides administrative services to BCBSNM, a Division of HCSC. BCBSNM makes no endorsement, representations or warranties regarding any products or services offered by independent third party vendors. If you have any questions about the products or services offered by such vendors, you should contact the vendors directly.

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


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