March 31, 2020
Our current electronic preauthorization submission tool, iExchange, will be deactivated on April 15, 2020. As of this date, all electronic preauthorization handled by Blue Cross and Blue Shield of New Mexico (BCBSNM) should be submitted using the Availity Authorizations tool. This includes preauthorization requests for inpatient admissions and select outpatient services handled by BCBSNM.
For Federal Employee Program® (FEP®), providers should continue to use their current preauthorization process until this the new tool becomes available in the near future.
Behavioral health services that require preauthorization handled by BCBSNM may now be submitted online via the Availity Authorizations tool.
- If you haven't registered with Availity, you can sign up for free on the Availity website . For help, contact Availity Client Services at 800-282-4548.
- The process of submitting preauthorization requests through eviCore healthcare (eviCore) or other vendors is not changing.
- Medical and surgical predetermination of benefits requests should be submitted via fax or mail by using the Predetermination Request Form, along with the pertinent medical documentation.
- Check the patient's eligibility and benefits first to determine if preauthorization is required for the service and/or procedure code. For online assistance, refer to the General Eligibility and Benefits Expanded Tip Sheet.
For More Information
Refer to the educational Availity Authorizations User Guide located under the Provider Tools section of our website. If you need further assistance or customized training, contact our Provider Education Consultants.
Please note that the fact that a service has been preauthorized/pre-notified is not a guarantee of payment. Benefits will be determined once a claim is received and will be based upon, among other things, the member's eligibility and the terms of the member's certificate of coverage applicable on the date services were rendered. If you have any questions, call the number on the member's ID card.
Availity is a trademark of Availity, LLC, a separate company that operates a health information network to provide electronic information exchange services to medical professionals. Availity provides administrative services to BCBSNM. iExchange is a trademark of Medecision, Inc., a separate company that provides collaborative health care management solutions for payers and providers. eviCore is an independent specialty medical benefits management company that provides utilization management services for BCBSNM. eviCore is wholly responsible for its own products and services. BCBSNM makes no endorsement, representations or warranties regarding any products or services provided by third party vendors such as Availity, eviCore or Medecision. If you have any questions about the products or services provided by such vendors, you should contact the vendor(s) directly.