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Addition of New Prior Authorization Requirements for Blue Cross Community CentennialSM Members

July 30, 2020

There are important changes to the prior authorizationrequirements for Blue Cross Community Centennial Members.

Beginning September 1, 2020, the following changes will be madeto the Blue Cross Community Centennial Prior Authorization Grid:

Code

Prior Authorization Source

Change

Effective Date

63688

BCBSNM

remove

9/1/2020

C9024

BCBSNM

remove

9/1/2020

C9028

BCBSNM

remove

9/1/2020

C9030

BCBSNM

remove

9/1/2020

C9032

BCBSNM

remove

9/1/2020

C9467

BCBSNM

remove

9/1/2020

C9492

BCBSNM

remove

9/1/2020

C9493

BCBSNM

remove

9/1/2020

C9016

BCBSNM

remove

9/1/2020

C9466

BCBSNM

remove

9/1/2020

97124

BCBSNM

remove

9/1/2020

 

Code

Prior Authorization Source

Change

Effective Date

0153U

eviCore

add

9/1/2020

0156U

eviCore

add

9/1/2020

0157U

eviCore

add

9/1/2020

0158U

eviCore

add

9/1/2020

0159U

eviCore

add

9/1/2020

0160U

eviCore

add

9/1/2020

0161U

eviCore

add

9/1/2020

0162U

eviCore

add

9/1/2020

0169U

eviCore

add

9/1/2020

0170U

eviCore

add

9/1/2020

0171U

eviCore

add

9/1/2020

81277

eviCore

add

9/1/2020

81307

eviCore

add

9/1/2020

81308

eviCore

add

9/1/2020

81522

eviCore

add

9/1/2020

81542

eviCore

add

9/1/2020

81552

eviCore

add

9/1/2020

97124

BCBS

remove

9/1/2020

77399

eviCore

remove

9/1/2020

63688

BCBS

remove

9/1/2020

C9024

BCBS

remove

9/1/2020

C9028

BCBS

remove

9/1/2020

C9030

BCBS

remove

9/1/2020

C9032

BCBS

remove

9/1/2020

C9467

BCBS

remove

9/1/2020

C9492

BCBS

remove

9/1/2020

C9493

BCBS

remove

9/1/2020

C9016

BCBS

remove

9/1/2020

C9466

BCBSNM

remove

9/1/2020

76873

eviCore

remove

9/1/2020

76965

eviCore

remove

9/1/2020

77261

eviCore

remove

9/1/2020

77262

eviCore

remove

9/1/2020

77263

eviCore

remove

9/1/2020

77280

eviCore

remove

9/1/2020

77285

eviCore

remove

9/1/2020

77290

eviCore

remove

9/1/2020

77293

eviCore

remove

9/1/2020

77295

eviCore

remove

9/1/2020

77299

eviCore

remove

9/1/2020

77300

eviCore

remove

9/1/2020

77301

eviCore

remove

9/1/2020

77306

eviCore

remove

9/1/2020

77307

eviCore

remove

9/1/2020

77316

eviCore

remove

9/1/2020

77317

eviCore

remove

9/1/2020

77318

eviCore

remove

9/1/2020

77321

eviCore

remove

9/1/2020

77331

eviCore

remove

9/1/2020

77332

eviCore

remove

9/1/2020

77333

eviCore

remove

9/1/2020

77334

eviCore

remove

9/1/2020

77336

eviCore

remove

9/1/2020

77338

eviCore

remove

9/1/2020

77370

eviCore

remove

9/1/2020

77417

eviCore

remove

9/1/2020

77427

eviCore

remove

9/1/2020

77431

eviCore

remove

9/1/2020

77432

eviCore

remove

9/1/2020

77435

eviCore

remove

9/1/2020

77469

eviCore

remove

9/1/2020

77470

eviCore

remove

9/1/2020

77499

eviCore

remove

9/1/2020

77789

eviCore

remove

9/1/2020

77790

eviCore

remove

9/1/2020

77799

eviCore

remove

9/1/2020

81200

eviCore

remove

9/1/2020

81205

eviCore

remove

9/1/2020

81507

eviCore

remove

9/1/2020

C9408

eviCore

remove

9/1/2020

0104U

eviCore

add

9/1/2020

0036U

eviCore

add

9/1/2020

81362

eviCore

add

9/1/2020

81322

eviCore

add

9/1/2020

81293

eviCore

add

9/1/2020

81289

eviCore

add

9/1/2020

A9590

eviCore

add

9/1/2020

0172U

eviCore

add

9/1/2020

0173U

eviCore

add

9/1/2020

0175U

eviCore

add

9/1/2020

0179U

eviCore

add

9/1/2020

 

It is important to use Availity®, or your preferred vendor, to check eligibility and benefits,determine if you are in-network for your patient, and whether anypreauthorization or prenotification is required. Availity allows you todetermine if preauthorization is required. Refer to the Eligibility and Benefits web page for more information onAvaility. Providers can also refer to the Prior Authorization section Blue Cross Community Centennial web page for more information regarding prior authorizations.

Such services are funded in part with the state of New Mexico.

As a reminder, it is important to check eligibility and benefitsprior to rendering services. This step will help you determine if benefit priorauthorization is required for a particular member. For additional information,such as definitions and links to helpful resources, refer to the Eligibilityand Benefits section on BCBSNM's provider website.

Please note that verification of eligibility and benefits,and/or the fact that a service or treatment has been preauthorized orpredetermined for benefits is not a guarantee of payment. Benefits will bedetermined 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 coverageapplicable on the date services were rendered. If you have questions, contactthe number on the member's ID card.

Availity is a trademark of Availity, L.L.C., a separate companythat operates a health information network to provide electronic informationexchange services to medical professionals. Availity provides administrativeservices to BCBSNM.

BCBSNM makes no endorsement, representations or warrantiesregarding any products or services offered by Availity, or Medecision. Thevendors are solely responsible for the products or services they offer. If you haveany questions regarding any of the products or services they offer, you shouldcontact the vendor(s) directly.