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Specialty Pharmacy Infusion Site of Care: Preauthorization Requirements

November 21, 2018

Effective Jan. 1, 2019, preauthorization will be required for select infusion drugs PDF Document for the Blue Cross and Blue Shield of New Mexico (BCBSNM) members in the networks listed below. These are drugs that are administered by health care professionals and typically covered under the member’s medical benefit.

  • Blue Community HMOSM
  • Blue Advantage HMOSM
  • Blue PreferredSM
  • Blue HMOSM
  • Blue PPOSM
  • Blue EPOSM

Starting on Jan. 1, 2019, if you are prescribing these select infusion drugs, you will need to submit a preauthorization request to BCBSNM prior to administration of the drug. To request preauthorization, use our online tool, iExchange®. You may also call the number on the member’s BCBSNM ID card for assistance.

Please note that verification of eligibility and benefits, and/or the fact that a service or treatment has been prior authorized or predetermined for benefits 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, contact the number on the member’s ID card.

iExchange is a trademark of Medecision, Inc., a separate company that provides collaborative health care management solutions for payers and providers. BCBSNM makes no endorsement, representations or warranties regarding any products or services provided by third party vendors such as Medecision. If you have any questions about the products or services provided by such vendors, you should contact the vendor(s) directly.