The Availity® Patient Cost Estimator (PCE) tool is an online member liability estimator that can help professional providers estimate a patient's potential out-of-pocket costs in real-time for office and outpatient services provided to Blue Cross and Blue Shield of New Mexico (BCBSNM) members.
The PCE is available free of charge to BCBSNM independently contracted providers who are registered with Availity.
How does the PCE determine an estimate?
- It analyzes the patient's primary diagnosis, procedures performed, available benefits and contractual allowances to calculate an estimate based on the information available at the time the estimate was processed.
- Actual coverage and member liability amounts are determined when the claim is processed.
The PCE allows your office the option of collecting the member's share at the point of service. You may not collect an amount greater than the amount listed by the PCE at the time services are rendered. Any overpayments must be refunded to the member within 30 days.
For more details, refer to the Availity Patient Cost Estimator User Guide*. To register with Availity , gain access to the free PCE tool and find out about other options, visit Availity's website , or call Availity Client Services at (800) AVAILITY (282-4548) for assistance.
Please note: Benefits will be determined once a claim is received by BCBSNM and will be based upon, among other things, the member's eligibility, benefits, limitations and exclusions and the terms of the member's certificate of coverage in effect on the date services are rendered.
* See the PCE User Guide for a brief list of exceptions.
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 any products or services provided by third party vendors such as Availity. If you have any questions about the products or services provided by such vendors, you should contact the vendor(s) directly.