Print

Update: New Benefit Preauthorization Requirements through eviCore

June 28, 2016

(Updated Sept. 23, 2016*)

*As of Sept. 26, 2016, providers will be able to contact eviCore to request preauthorization for dates of service on and after Oct. 3, 2016, for outpatient molecular and genomic testing and outpatient radiation therapy. You can reach eviCore at evicore.com  or toll-free at 855-252-1117. Access to eviCore healthcare’s preauthorization call center is available from 7 a.m. to 7 p.m. Monday through Friday.

Effective October 3, 2016, Blue Cross and Blue Shield of New Mexico (BCBSNM) has contracted with eviCore healthcare (eviCore), an independent specialty medical benefits management company, to provide authorization services for the new requirements outlined below. 

eviCore will manage pre-service authorization for outpatient molecular and genomic tests and outpatient radiation therapy for dates of service beginning October 3, 2016. 

Services performed without preauthorization may be denied for payment, and the rendering provider may not seek reimbursement from members. 

You will continue to use iExchange® for all other services that require a referral and/or preauthorization. 

Both BCBSNM and eviCore will be providing additional information and training opportunities in the coming months on the Provider website at bcbsnm.com/provider and in Blue Review. You may also contact your Network Management Consultant for more information. 

Note: Physicians, professional providers, facility and ancillary providers who are contracted/affiliated with an IPA/PHO must contact the IPA/PHO for questions and information regarding the preauthorization requirements.