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Benefit Information Accessible in the IVR Phone System

May 2, 2017

Starting on Dec. 12, 2016, Customer Advocate assistance was removed for several common benefit categories within the Interactive Voice Response (IVR) phone system. The IVR quotes the same level of patient eligibility and benefits information as a Customer Advocate provides.  Remain assured; our Advocates will continue to be available for more complex benefit quotes.

Blue Cross and Blue Shield of New Mexico (BCBSNM) is committed to providing efficient and secure access to patient information. To better assist providers with understanding the recent IVR change, a list of the benefit categories that are currently contained in the IVR is included below. This listing is continually reviewed and may vary across our different BCBSNM networks, products and/or group policies. Also included below is a separate category containment list for Federal Employee Program (FEP) members. 

IVR Contained Benefit Categories

Office Visit

Hospital

Preventive Care

Colonoscopy

Allergy

Ultrasound

Coordinated Home Care

Laboratory

X-ray

Extended Care Facility

Mammogram

EKG

Physical Exam

Inhalation Therapy

Consultations

Pap Smear

Private Duty Nursing

Office Services

 

FEP IVR Contained Benefit Categories

Accidental Injury

Maternity

Allergy

Office Visit

Chiropractic Services

Outpatient Physical, Occupational and Speech Therapy

Diagnostic – Lab, X-ray, Outpatient Diagnostic

Vision

Inpatient Benefits – Inpatient Hospital, Inpatient Surgery

 

When navigating the IVR to determine patient coverage or connecting with a Customer Advocate to request pre-determination of benefits status, it is imperative that you select the exact benefit category that will be rendered for the patient. This will ensure that you receive the most accurate benefit information associated with your request.

Checking eligibility and benefits electronically through Availity™ or your preferred Web vendor is the quickest way to access information for BCBSNM members. To learn more about online solutions, refer to the Education and Reference Center/Provider Tools section of our website at bcbsnm.com/provider. For IVR navigational assistance, refer to the Eligibility and Benefit Caller Guide found on our Provider website.

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 and the terms of the member’s certificate of coverage applicable on the date services were rendered.  If you have questions, please call the number on the member’s ID card.

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. BCBSNM makes no endorsement, representations or warranties regarding any products or services offered by third party vendors such as Availity. If you have any questions about the products or services offered by such vendors, you should contact the vendor(s) directly.