BCBSNM Moving Prior Authorization Duties from eviCore to AIM Effective Jan. 1, 2021, for Some Members

October 29, 2020

What’s changing?
Our vendor who processes prior authorizations for certain Blue Cross and Blue Shield of New Mexico (BCBSNM) group and individual members and Blue Cross Community CentennialSM members is changing. Starting Jan. 1, 2021, AIM Specialty Health® (AIM) will handle our prior authorizations for these members. eviCore healthcare will no longer handle our prior authorizations for these members effective Jan. 1, 2021. We are also adding prior authorization requirements for our Blue Cross Community CentennialSM members.

What is not changing?
The care categories that require prior authorization for group and individual members will stay the same:

  • Advanced imaging
  • Cardiology
  • Genetic testing
  • Joint and spine surgery
  • Pain management
  • Radiation therapy
  • Sleep medicine

What’s new for Blue Cross Community Centennial members?
Starting on Jan. 1, 2021, the following care categories will be delegated to AIM for prior authorization requests for Blue Cross Community Centennial members.

  • Acute rehabilitation therapy* (physical, occupational, speech)
  • Advanced imaging*
  • Joint and spine surgery*
  • Molecular and genomic testing
  • Outpatient radiation therapy
  • Pain management*
  • Sleep medicine*

*New care categories requiring prior authorization 

Learn more about prior authorization in BCBSNM, including code lists for the services that require prior authorization on our website. Remember code lists are periodically updated.

Check eligibility and benefits first to confirm membership, check coverage, determine if you are in-network for the member’s policy and determine whether prior authorization is required through Availity® Learn more about third-party links or your preferred vendor. This step will help you confirm coverage and other important details, such as prior authorization requirements and vendors, if applicable.

How can you prepare?
Make sure you have an account with AIM. To create an account:

  • Access AIM ProviderPortal Learn more about third-party links, or
  • By Phone – Call the AIM Contact Center at 800-859-5299 Monday through Friday, 6 a.m. to 6 p.m., CT; and 9 a,m. to noon, CT on weekends and holidays.

If you are already registered with AIM you do not need to register again.

How to submit a prior authorization request through AIM starting Jan. 1, 2021
Submit prior authorization requests to AIM in one of the following ways:

  • Online – Submit requests via the AIM ProviderPortal Learn more about third-party links 24/7.
  • By Phone – Call the AIM Contact Center at 800-859-5299 Monday through Friday, 6 a.m. to 6 p.m., CT; and 9 a,m. to noon, CT on weekends and holidays.

Why it matters
If benefit prior authorization is required, services performed without benefit prior authorization or that do not meet medical necessity criteria may be denied for payment and the rendering provider may not seek reimbursement from the member.

Which members and services need prior authorization?
Use Availity® or your preferred vendor to:

  • Check eligibility and benefits
  • Determine if you’re in-network for your patient
  • Find out if the patient and service(s) require prior authorization 

Look for future News and Updates on upcoming training and FAQs that will provide all of the important information you need to successfully transition to AIM.

AIM Specialty Health (AIM) is an operating subsidiary of Anthem, Inc., an independent specialty medical benefits management company that provides utilization management services for BCBSNM.

Learn more about third-party links By clicking this link, you will go to a new website/app (“site”). This new site may be offered by a vendor or an independent third party. The site may also contain non-Medicare related information. In addition, some sites may require you to agree to their terms of use and privacy policy.

Such services are funded in part with the State of New Mexico.

eviCore is a trademark of eviCore healthcare, LLC, formerly known as CareCore, an independent company that provides utilization review for select health care services on behalf of BCBSNM.

Availity is a trademark of Availity, L.L.C., a separate company that operates a health information network to provide electronic information exchange services to medical professionals. Availity provides administrative services to BCBSNM.

Blue Cross and Blue Shield of New Mexico, a Division of Health Care Service Corporation, a Mutual Legal Reserve Company, an Independent Licensee of the Blue Cross and Blue Shield Association