New Predetermination Process
Blue Cross and Blue Shield of New Mexico (BCBSNM) is working to improve efficiency by decreasing the number of services requiring preauthorization. Recognizing that there may be certain services that you will want to confirm coverage in writing before the requested service is rendered, we have implemented a new process called predetermination.
When using this new process you can submit outpatient service requests in writing by fax at 505-816-3608 or by mail at P.O. Box 27630, Albuquerque, NM 87125-7630. With the predetermination form 
you can also submit any supporting documentation.
Predeterminations and preauthorizations will be accepted using either form and will be processed within the same five day time period.
Examples of predetermination requests are:
- outpatient services
- durable medical equipment requests
- surgeries that might be considered cosmetic
- possible experimental and investigational procedures
Preauthorization is still required for:
- all inpatient admissions
- pharmacy requests
- air ambulance
Both predetermination and preauthorization requests will be reviewed by a nurse. The medical director and the pharmacist may be involved in the decision making process.
Medical records (clinical) are not needed unless requested by BCBSNM. Preauthorizations can be called in at 800-325-8334 or faxed using the preauthorization form .
Health services is always available by phone at 800-325-8334 for any urgent requests or questions.
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