Print

Prior Authorization Changes for ID Prefixes BBE, BHP, BNK, BRG and BYR

February 6, 2020

Effective March 1, 2020, some Blue Cross and Blue Shield of Illinois (BCBSIL) members in New Mexico will have new prior authorization requirements through eviCore healthcare (eviCore). The members have the following ID prefixes:

  • BBE
  • BHP
  • BNK
  • BRG
  • BYR

Services Requiring Prior Authorization

The new requirements apply to the following outpatient services:

  • Advanced Imaging
  • Cardiology
  • Genetic Testing
  • Joint and Spine Surgery
  • Pain Management
  • Radiation Therapy
  • Sleep Studies

eviCore Instructions

There are two ways to secure a prior authorization through eviCore:

  • Online – The eviCore web portal is the quickest way to open a case, check status, review guidelines and more.
  • By phone – Call eviCore at 855-252-1117 between 7 a.m. and 7 p.m. (CT), Monday through Friday.

Requirements Vary by Member

Prior authorization requirements are specific to each member based on their benefit plan. Check eligibility and benefits before rendering services. Submitting an electronic 270 transaction via the Availity® Provider Portal or your preferred vendor portal provides information about:

  • Coverage
  • Network status
  • Prior authorization requirements
  • Other important details

Obtaining benefit prior authorization is not a substitute for checking eligibility and benefits. We will not pay for services performed without required benefit prior authorization. Providers may not seek reimbursement from BCBSNM members. If you have any questions, contact 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. eviCore is an independent specialty medical benefits management company that provides utilization management services for BCBSNM. BCBSNM makes no endorsement, representations or warranties regarding any products or services provided by third party vendors such as Availity or eviCore. If you have any questions about the products or services provided by such vendors, you should contact the vendor(s) directly.