31 de julio de 2020
Our current electronic benefit prior authorization and predetermination of benefits request tool, iExchange, will be deactivated on August 17, 2020. As of this date, all electronic benefit prior authorization and predetermination requests handled by Blue Cross and Blue Shield of New Mexico (BCBSNM) should be submitted online via the Availity® Provider Portal.
How to Submit Online Benefit Prior Authorization Requests
Benefit prior authorization requests for inpatient admissions and select outpatient services handled by BCBSNM may be submitted online using Availity’s Authorizations tool. Refer to the educational Availity Authorizations User Guide, located in the Provider Tools section of our website for navigational assistance. The process of submitting benefit prior authorization requests to eviCore healthcare (eviCore) or other vendors has not changed.
As a reminder, it's imperative to check the patient's eligibility and benefits online first to determine if the service requires prior authorization. For online assistance, refer to the General Eligibility and Benefits Expanded User Guide.
How to Submit Online Benefit Prior Authorization Requests
As of July 30, 2020, predetermination of benefit requests handled by BCBSNM may be submitted electronically using Availity’s Attachment tool. Watch for the new Electronic Predetermination of Benefits user guide coming soon to the Herramientas section.
As a reminder, a predetermination of benefits is a voluntary request for written verification of benefits prior to rendering services. BCBSNM recommends submitting a predetermination of benefits request if the service may be considered experimental, investigational or unproven, as specified within BCBSNM Medical Policy 
.
If you don't have online access, you may continue to fax and/or mail predetermination of benefit requests along with a completed Predetermination Request Form and supporting medical documentation. If faxing supporting medical documentation for a previously submitted request, please include the request number.
Submitting predetermination of benefits via Availity does not apply to requests for Medicare Advantage members.
Para Más Información
You must be registered with Availity to use the Authorizations and Attachments tools. You can sign up today at Availity , at no charge. For registration assistance, call Availity Client Services at 800-282-4548.
If you need further assistance or customized training for these Availity solutions, contact our Provider Education Consultants.
Please note that the fact that a service has been preauthorized/pre-notified, that a guideline is available for any given treatment or that a service or treatment has been predetermined for benefits, 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.