31 de marzo de 2020
Our current electronic preauthorization submission tool, iExchange, will be deactivated on April 15, 2020. As of this date, all electronic preauthorization handled by Blue Cross and Blue Shield of New Mexico (BCBSNM) should be submitted using the Availity Authorizations tool. This includes preauthorization requests for inpatient admissions and select outpatient services handled by BCBSNM.
For Federal Employee Program® (FEP®), providers should continue to use their current preauthorization process until this the new tool becomes available in the near future.
UPDATE
Behavioral health services that require preauthorization handled by BCBSNM may now be submitted online via the Availity Authorizations tool.
Recordatorios importantes
- If you haven't registered with Availity, you can sign up for free on the Sitio web de Availity
. For help, contact Availity Client Services at 800-282-4548. - The process of submitting preauthorization requests through eviCore healthcare (eviCore) or other vendors is not changing.
- Medical and surgical predetermination of benefits requests should be submitted via fax or mail by using the Predetermination Request Form, along with the pertinent medical documentation.
- Check the patient's eligibility and benefits first to determine if preauthorization is required for the service and/or procedure code. For online assistance, refer to the General Eligibility and Benefits Expanded Tip Sheet.
Para Más Información
Refer to the educational Availity Authorizations User Guide located under the Provider Tools section of our website. If you need further assistance or customized training, contact our Provider Education Consultants.
Please note that the fact that a service has been preauthorized/pre-notified is not a guarantee of payment. Los beneficios se determinarán una vez que se reciba el reclamo y se basarán, entre otras cosas, en la elegibilidad del asegurado y los términos del certificado de asegurado de la cobertura aplicable en la fecha en la que se prestaron los servicios. If you have any questions, call the number on the member's ID card.
Availity es una marca registrada de Availity, LLC, una compañía aparte que opera una red de información de salud para prestar servicios de intercambio de información electrónica a profesionales médicos. Availity provides administrative services to BCBSNM. iExchange is a trademark of Medecision, Inc., a separate company that provides collaborative health care management solutions for payers and providers. eviCore is an independent specialty medical benefits management company that provides utilization management services for BCBSNM. eviCore is wholly responsible for its own products and services. BCBSNM makes no endorsement, representations or warranties regarding any products or services provided by third party vendors such as Availity, eviCore or Medecision. Si tiene alguna pregunta acerca de los productos o servicios ofrecidos por estos proveedores, debe comunicarse con el proveedor directamente.