Extending Prior Authorization on Previously-Approved Elective Surgeries, Procedures, and Therapies
Blue Cross and Blue Shield of New Mexico (BCBSNM) temporarily extending approvals on services with existing prior authorizations until Dec. 31, 2020. This applies to services that were originally approved or scheduled between Jan. 1 and June 1, 2020. This is for most non-emergent, elective surgeries, procedures, therapies and home visits.
A member may reschedule an approved procedure to a later date within 2020 without a new prior authorization. This applies only to active members for a benefit that is covered under their plan at the time services are rendered.
- BCBSNM will honor all prior authorizations on non-emergent surgeries, procedures, therapies and home visits approved or scheduled between Jan. 1 and June 1, 2020.
- These prior authorizations are approved through Dec. 31, 2020, so approved procedures can be rescheduled before Dec. 31, 2020.
- Therapy sessions and home visits authorized for a specific number of occurrences between Jan. 1 and April 1, 2020 will have the same number of occurrences available through the end of the year.
- These rules apply to current members for a benefit that is currently covered under their plan.
Is this for all members?
This is for all group, fully-insured, retail, self-funded, and Medicare Advantage members.
Medicaid plan prior authorization will be extended according to those plan rules, including but not limited to current state Medicaid waivers in place that extend prior authorizations. Medicaid will continue to assess the need to extend prior authorization, consistent with Medicaid requirements.
Excluded prior authorizations
Prior authorizations for specialty medications are not extended. You must submit a new request for specialty medications.
How to extend prior authorizations
You do not need to do anything; the authorizations are automatically extended.
Additional services or sessions
For additional services or sessions, you must submit a new prior authorization request.
If you have any questions or concerns regarding this communication, please contact your Provider Relations Representative.