Beginning Sept. 8, 2020, the option to speak to a Customer Advocate will be removed for the physical therapy benefit category within our automated Interactive Voice Response (IVR) phone system. The IVR quotes the same level of patient eligibility and benefits information as a Customer Advocate provides. Remain assured; our Customer Advocates will continue to be available for more complex benefit quotes.
Blue Cross and Blue Shield of New Mexico (BCBSNM) is committed to providing efficient and secure access to patient information. To better assist providers with understanding the recent IVR change, a list of the benefit categories that are currently contained in the IVR is included below. This listing is continually reviewed and may vary across our different BCBSNM networks, products and/or group policies. This change does not impact the Federal Employee Program® (FEP®) IVR.
Note: This information/listing is not applicable to Medicare Advantage members. When calling to verify eligibility and benefits for one of these members, refer to the Customer Services phone number on the back of the member’s BCBSNM ID card.
| Air Ambulance | Electrocardiogram (EKG) | Medical Supplies | Physical Therapy** |
| Allergy | Extended Care Facility | MRI | Preventive Care |
| Anesthesia | Ground Ambulance) | Office Services | Private Duty Nursing |
| Assistant Surgeon | Hospice | Office Visit* | Prosthetics |
| CAT Scan | Hospital | Pap Smear | Prostate-specific Antigen (PSA) |
| Colonoscopy | Inhalation Therapy | Pathology | Sterilization |
| Consultations | Laboratory | PET Scan | Ultrasound |
| Dialysis | Mammogram | Physical Exam | 23-Hour Observation |
*Customer Advocate assistance is temporarily available for office visit due to COVID-19.
**Physical Therapy will be contained in the IVR beginning as of Sept. 8, 2020.
When using the IVR to determine patient coverage or connecting with a Customer Advocate to request predetermination of benefits status, it is imperative that you select the exact benefit category that will be rendered for the patient. This will ensure that you receive the most accurate benefit information associated with your request. For additional help with navigating the IVR, refer to the Eligibility and Benefits Caller Guide in the Claims and Eligibility section of our Provider website.
Consider Electronic Options
Checking eligibility and benefits electronically through Availity® or your preferred Web vendor is the quickest way to access information for BCBSNM members. To learn more about online solutions, refer to the Provider Tools section of our website.
Checking eligibility and/or benefit information 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 questions, please 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. 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.