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Medicare Clinical Guidelines 

Blue Cross and Blue Shield of New Mexico uses Medicare and internal medical policies to make sure you get the health care you need. Our clinical team uses evidence-based clinical guidelines to make sure you can get safe and necessary care. Policies are based on scientific and medical research. There are no rewards to deny or promote care.

Always talk to your doctor about any health questions or concerns. You can also check with your doctor if you have questions about prior authorization or medical policies.

Use the links below to review BCBSNM and vendor guidelines that may apply.

If you want to know more about the utilization management process or how decisions are made about your care, Contact Us.

*Licensee's use and interpretation of the American Society of Addiction Medicine's ASAM Criteria for Addictive, Substance-Related, and Co-Occurring Conditions does not imply that the American Society of Addiction Medicine has either participated in or concurs with the disposition of a claim for benefits.