The Availity provider engagement portal helps providers and Blue Cross and Blue Shield of New Mexico (BCBSNM) to securely share information easily and efficiently. Using Availity allows you to quickly verify patient eligibility and benefits, confirm prior authorization requirements, submit prior authorization requests, check claim status, obtain provider claim summaries, and more without having to call BCBSNM.
Advantages of using Availity
- Accessible 24/7
- HIPAA Compliant
- Multi-Payer Solution
- Real-time Search Results
- No Cost Transactions
- Printable Results
- Online Help Features
Electronic Provider Tools
The following complimentary self-service tools are accessible through Availity and can be used to accomplish multiple tasks and gain information.
Pre-Service Tools |
Description |
|---|---|
Eligibility and Benefits Inquiry |
verify real-time patient activity, check coverage details and determine prior authorization requirements |
Patient Care Summary |
consolidated view of a patient's health care history |
Patient Cost Estimator* |
estimate a patient's potential out-of-pocket costs |
Patient ID Finder* |
obtain the BCBSNM patient ID and group number |
Attachments* |
submit predetermination of benefits requests handled by BCBSNM |
Authorizations |
submit prior authorization requests handled by BCBSNM |
Altruista Health's GuidingCareTM (single sign-on access) |
monitor rendered services, activities, quality measures and care plans for Blue Cross Community CentennialSM members |
Post-Service Tools |
Description |
Claim Status |
check detailed, real-time claim status |
Research Procedure Code Edits (Clear Claim Connection)* |
determine how coding combinations on a specific claim may be evaluated during the adjudication process |
Reporting On-Demand |
view, download, save and/or print the Provider Claim Summary (PCS) for finalized claims |
Remittance Viewer |
offers providers and billing services a convenient way to view and help reconcile claim data in the 835 Electronic Remittance Advice (ERA) |
Electronic Refund Management (eRM)* |
reconcile claim overpayments and manage refund requests |
Claim Inquiry Resolution (CIR)* |
submit claim reconsideration request for certain finalized claims |
Medical Attachment |
receive and electronically respond to medical record requests for quality and risk adjustment |
Clinical Quality Validation (CQV) |
comply with Healthcare Effectiveness Data and Information Set (HEIDIS) measures by electronically documenting the patient's care and assessment |
*Not available for Medicare Advantage members.
If you have not yet registered for Availity 
, you can sign up today at no charge. For registration assistance, you may contact Availity Client Services at 800-282-4548.
For More Information
Refer to the Training page to register for upcoming online training sessions.
Have additional questions or need customized training? Email our Provider Education Consultants for assistance.
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 any 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. GuidingCare is a trademark of Altruista Health., a separate company that offers collaborative health care management solutions for payers and providers. BCBSNM makes no endorsement, representations or warranties regarding any products or services provided by third-party vendors such as Availity and GuidingCare. If you have any questions about the products or services provided by such vendors, you should contact the vendor(s) directly.
ClaimsXten and Clear Claim Connection are trademarks of Change Healthcare, an independent company providing coding software to BCBSM. Change Healthcare is solely responsible for the software and all the contents. Contact the vendor directly with any questions about the products, software and services they provide.