The BlueApprovR utilization management tool is integrated with Availity® Authorizations at Availity Essentials. This configuration assists you with the authorization process for behavioral health services.
BlueApprovR is designed to help simplify the provider submission process by asking for the information to support a medical necessity determination.
To submit initial behavioral health prior authorizations online:
- In Availity, select Patient Registration from the navigation menu
- Then select Authorizations & Referrals
- On the Authorizations & Referrals page, select Authorization Requests
Behavioral Health concurrent reviews and edits are available by accessing the initial authorization request from the Availity Authorization/Referral Dashboard and selecting Update.
- Concurrent requests can only be submitted via Availity if the initial request started in Availity Authorizations.
- If the initial request was created by phone or fax, the concurrent review must also be submitted by phone or fax.
For additional details, refer to Availity Authorizations Tools to learn more and view instructional user guides.
Training Sessions:
Training is available for you to learn how to electronically submit your request via Availity. You must be a current Availity user to register and attend these training sessions.
Note: This behavioral health/BlueApprovR integration with Availity Authorizations is currently not available for New Mexico Medicaid members. Please use your existing process for requesting prior authorization for these members.
Checking eligibility and/or benefit information, obtaining prior authorization or the fact that a recommended clinical review (predetermination) decision has been issued 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, including, but not limited to, exclusions and limitations applicable on the date services were rendered. Regardless of any prior authorization or recommended clinical review (predetermination), the final decision regarding any treatment or service is between the patient and the health care provider. If you have any questions, 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 third party vendors and the products and services they offer.