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Additional Benefit Categories Contained in IVR Phone System

July 12, 2017

Our May 2017 Blue Review included a list of the common benefit categories contained within the Blue Cross and Blue Shield of New Mexico (BCBSNM) Interactive Voice Response (IVR) phone system. Beginning June 19, 2017, the list will be expanded to include additional common benefit categories. The IVR quotes the same level of eligibility and benefit information as a Customer Advocate provides. Our Customer Advocates will continue to be available for more complex benefit quotes.

To help ensure provider readiness, an updated IVR benefit containment list is included below. This list outlines those categories that were effective starting on Dec. 12, 2016, along with the additional categories to be implemented June 19, 2017. As a reminder, this information is continually reviewed and may vary across different BCBSNM networks, products and/or group policies. There are no other benefit categories being added to the Federal Employee Program (FEP) IVR-Contained Benefits list at this time. To view the separate containment list for FEP members, refer to the article in the May 2017 Blue Review.

Note: The information listed is not applicable to government programs (Medicare Advantage) member policies. For government programs eligibility and benefits requests via phone, refer to the number on the member's BCBSNM ID card.

IVR-Contained Benefit Categories Effective Dec. 12, 2016

Additional IVR-Contained Benefit Categories Effective June 19, 2017

  • Allergy
  • Colonoscopy
  • Consultations
  • Coordinated Home Care
  • Electrocardiogram (EKG)
  • Extended Care Facility
  • Hospital
  • Inhalation Therapy
  • Laboratory
  • Mammogram
  • Office Services
  • Office Visit
  • Pap Smear
  • Physical Exam
  • Preventive Care
  • Private Duty Nursing
  • Ultrasound
  • X-ray
  • 23-hour Observation
  • Air Ambulance
  • Anesthesia
  • Assistant Surgeon
  • CAT Scan
  • Dialysis
  • Ground Ambulance
  • Hospice
  • Medical Supplies
  • MRI
  • Pathology
  • PET Scan
  • Prosthetics
  • Prostate-specific Antigen (PSA)
  • Sterilization

As a reminder, checking eligibility and benefits electronically through AvailityTM 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 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, 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 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.

Blue Cross®, Blue Shield® and the Cross and Shield Symbols are registered service marks of the Blue Cross and Blue Shield Association, an association of independent Blue Cross and Blue Shield Plans.