December 11, 2020
As we told you in News and Updates in October, 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 authorization for these members. eviCore healthcare will no longer handle our prior authorization and post-service reviews for these members effective Jan. 1, 2021. We are also adding prior authorization requirements for our Blue Cross Community CentennialSM members.
This update below includes additional information: including key dates to consider as we transition care for some members between eviCore and AIM; new contact information for AIM and hours of operation; and reminders on upcoming training dates.
Consider these Key Dates and Scenarios During the Transition of Care between eviCore and AIM
- AIM's ProviderPortal will be open for you to begin submitting prior authorization requests on Dec. 21, 2020, for dates of service on or after Jan. 1, 2021.
- Do not submit prior authorization requests to eviCore for dates of service on or after Jan. 1, 2021.
- Continue to submit prior authorization requests to eviCore through Dec. 31, 2020, for dates of service before or on Dec. 31, 2020.
Join Us for A Webinar to Learn More
It's important to attend an online training session for more in-depth information how to use the AIM ProviderPortal. Click here to view and register for training sessions .
Update: Use the AIM ProviderPortal for Pre & Post-Service Reviews
Use the AIM ProviderPortal to request prior authorization and respond to post-service review requests by AIM. Do not submit medical records to BCBSNM for prior authorization or post-service reviews for the care categories managed by AIM. Medical records may or may not be needed for pre or post service reviews using the AIM portal due to the smart clinical algorithms within the portal.
Benefits of the AIM ProviderPortal for Pre & Post-Service Reviews
- Medical records for pre or post-service reviews are not necessary unless specifically requested by AIM.
- AIM's ProviderPortal offers self-service, smart clinical algorithms and in many instances real-time determinations
- Check prior authorization status on the AIM ProviderPortal
- Increase payment certainty
- Faster pre-service decision turnaround times than post service reviews
Other Important Reminders
Make sure you're registered with AIM, prior to Jan. 1, 2021. There are two ways to register:
- Online – Go to the AIM ProviderPortal; or
- By Phone – Call the AIM Contact Center at 866-745-1789, Monday through Friday, 7 a.m. to 7 p.m., CT.
Member benefits will vary based on the service being rendered and individual and group policy elections. Always check eligibility and benefits first, through the Availity® Provider Portal or your preferred web vendor, prior to rendering services. This step will help you confirm coverage and other important details, such as prior authorization requirements and vendors, if applicable. If prior authorization is required, services performed without 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.
Learn more about prior authorization with BCBSNM and find code lists for the services that require prior authorization on our website. Remember code lists are periodically updated.
For More Information
Continue to watch the News and Updates for reminders, announcements and educational resources. that will help you transition to submitting commercial prior authorization requests through AIM.