April 9, 2021
As a reminder, for dates of service on or after Jan. 1, 2021, AIM Specialty Health is the utilization management vendor for Blue Cross and Blue Shield of New Mexico (BCBSNM) commercial and Blue Cross Community Centennial(SM) prior authorization requests that were formerly handled by eviCore Healthcare®. To assist providers with this transition, in December 2020, a notice appeared on the eviCore website to alert providers of the appeals run-out process, which will continue through April 2021.
If you submitted a prior authorization (pre-service) request through eviCore and that request was denied, or if eviCore conducted a post-service (post-claim) medical necessity review resulting in an adverse determination, your letter will instruct that peer-to-peer discussions and appeals must be requested through eviCore. Please note that, for these pre- and post-service adverse determinations, eviCore will continue to process peer-to-peer and appeal requests through April 30, 2021, only. After April 30, 2021, eviCore will redirect any peer-to-peer and appeal requests to BCBSNM.
Check eligibility and benefits through Availity® or your preferred vendor, to:
- Determine whether prior authorization is required
- Confirm benefit coverage
- Determine which vendor to use for prior authorization
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, any claims received during the interim period and the terms of the member’s certificate of coverage applicable on the date services were rendered
eviCore healthcare (eviCore) is an independent specialty medical benefits management company that provides utilization management services for BCBSNM.
AIM Specialty Health (AIM) is an independent company that has contracted with BCBSIL to provide utilization management services for members with coverage through 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