Enteral Nutrition Covered Benefit Changes

August 4, 2016

Blue Cross and Blue Shield of New Mexico requires preauthorization for enteral nutrition benefits. Effective August 1, 2016, preauthorization requests must be submitted to the fax or phone numbers listed below. Once benefits are approved, enteral nutrition must be billed as a medical claim following HCPCS billing procedures and are to be billed as billable units, which is unique to each HCPCS code.

This benefit change will not affect members. Pharmacies enrolled as a medical provider with Centennial Care can continue to provide enteral nutrition to members. Pharmacies need to bill these products as a medical claim instead of a pharmacy claim.

Enteral Nutrition Preauthorization Requests
Fax: (505) 816-3854
Phone: (877) 232-5518

Additional information on prior authorization criteria used in the review can be found here.

Pharmacies with medical claim inquiries can contact (800) 693-0663.