Submit Predetermination of Benefits Requests via the Availity®

July 27, 2020

Blue Cross and Blue Shield of New Mexico (BCBSNM) is excited to introduce an electronic predetermination of benefits request process via the Availity Provider Portal using the Attachments tool. This new process is available to providers as of July 30, 2020, making it faster and easier to submit a predetermination of benefits request to BCBSNM.

As a reminder, a predetermination of benefits is a voluntary request for written verification of benefits prior to rendering services. BCBSNM recommends submitting a predetermination of benefits request if the service may be considered experimental, investigational, or unproven, as specified within the BCBSNM Medical Policy.

You must be registered with Availity to use the new Attachments tool. You can sign up today at Availity Learn more about third-party links, at no charge. For registration assistance, call Availity Client Services at 800-282-4548.

Note: If you don't have online access, you may continue to fax and/or mail predetermination of benefit requests along with a completed Predetermination Request Form and pertinent medical documentation.

How does the new online process work?

Submitting online predetermination of benefits requests through the Availity Attachments application is simple and convenient:

  • Log in to Availity Learn more about third-party links
  • Select Claims & Payments from the navigation menu
  • Select Attachments – New
  • Within the tool, select Send Attachment then Predetermination Attachment
  • Download and complete the Predetermination Request Form
  • Complete the required data elements
  • Upload the completed form and attach supporting documentation
  • Select Send Attachment(s)

BCBSNM is hosting complimentary webinars for you to learn how to submit an electronic predetermination request. Simply click on your preferred date and time below to register.

  • August 3, 2020 – 12:30 p.m. to 1 p.m. Learn more about third-party links
  • August 4, 2020 – 8 a.m. to 8:30 a.m. Learn more about third-party links
  • August 5, 2020 – 10 a.m. to 10:30 a.m. Learn more about third-party links
  • August 6, 2020 – 2 p.m. to 2:30 p.m. Learn more about third-party links
  • August 7, 2020 – 9 a.m. to 9:30 a.m. Learn more about third-party links

For More Information
If you need further assistance or customized training, contact our Provider Education Consultants. Also watch for a new Electronic Predetermination Request user guide, coming soon to the Tools section of our website.

The information in this notice does not apply to requests for Medicare Advantage members.

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. BCBSNM makes no endorsement, representations or warranties regarding any products or services provided by third party vendors such as Availity. If you have any questions about the products or services provided by such vendors, you should contact the vendor(s) directly.