Print

Extending Prior Authorization on Previously-Approved Elective Surgeries, Procedures and Therapies (Updated)

May 14, 2020

Blue Cross and Blue Shield of New Mexico (BCBSNM) is 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 30, 2020 (previously April 1, 2020). This is for most non-emergent, elective surgeries, procedures, therapies, home visits and behavioral health services.

A member may reschedule an approved procedure to a later date in 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.

We will continue to monitor the national health emergency and will update as appropriate.


Details

  • BCBSNM will honor all BCBSNM prior authorizations on non-emergent surgeries, procedures, therapies, home visits and behavioral health services approved or scheduled between Jan. 1, 2020, and June 30, 2020 (previously April 1, 2020).
  • These prior authorizations will remain approved through Dec. 31, 2020. Approved services can be rescheduled with the authorized provider any time before Dec. 31, 2020, based on provider availability.
  • Therapy sessions and home visits authorized for a specific number of occurrences between Jan. 1, 2020, and June 30, 2020 (previously April 1, 2020), will have the same number of occurrences available to an eligible member 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.


What you need to do

You do not need to do anything to extend an authorization; it will be automatically extended.

Please notify us when services subject to a prior authorization are rendered. For inpatient admissions, let us know when one of our members is admitted to your facility.


Excluded prior authorizations

Prior authorizations for specialty medications are not extended. You must submit a new request for specialty medications.


Additional services or sessions

If a member seeks additional services or sessions, you must submit a new prior authorization request to BCBSNM for those additional services or sessions.