Beginning Sept. 8, 2020, the option to speak to a Customer Advocate will be removed for the physical therapy benefit category within our automated Interactive Voice Response (IVR) phone system. The IVR quotes the same level of patient eligibility and benefits information as a Customer Advocate provides. Remain assured; our Customer Advocates will continue to be available for more complex benefit quotes.
Blue Cross and Blue Shield of New Mexico (BCBSNM) is committed to providing efficient and secure access to patient information. To better assist providers with understanding the recent IVR change, a list of the benefit categories that are currently contained in the IVR is included below. This listing is continually reviewed and may vary across our different BCBSNM networks, products and/or group policies. This change does not impact the Federal Employee Program® (FEP®) IVR.
Note: This information/listing is not applicable to Medicare Advantage members. When calling to verify eligibility and benefits for one of these members, refer to the Customer Services phone number on the back of the member’s BCBSNM ID card.
| Ambulancia aérea | Electrocardiogram (EKG) | Suministros médicos | Physical Therapy** |
| Alergia | Centro de Cuidados Extendidos | Resonancia magnética | Cuidado Preventivo |
| Anestesia | Ground Ambulance) | Office Services | Enfermería privada |
| Assistant Surgeon | Centro paliativo | Office Visit* | Prótesis |
| Tomografía computar | Hospital | Pap Smear | Prostate-specific Antigen (PSA) |
| Colonoscopía | Terapia de inhalación | Patología | Sterilization |
| Consultations | Laboratorio | PET Scan | Ultrasonido |
| Diálisis | Mamografía | Examen físico | 23-Hour Observation |
*Customer Advocate assistance is temporarily available for office visit due to COVID-19.
**Physical Therapy will be contained in the IVR beginning as of Sept. 8, 2020.
When using the IVR to determine patient coverage or connecting with a Customer Advocate to request predetermination of benefits status, it is imperative that you select the exact benefit category that will be rendered for the patient. This will ensure that you receive the most accurate benefit information associated with your request. For additional help with navigating the IVR, refer to the Eligibility and Benefits Caller Guide in the Claims and Eligibility section of our Provider website.
Consider Electronic Options
Checking eligibility and benefits electronically through Availity® or your preferred Web vendor is the quickest way to access information for BCBSNM members. To learn more about online solutions, refer to the Herramientas section of our website.
Checking eligibility and/or benefit information 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 questions, please 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 presta servicios administrativos a BCBSNM. BCBSNM makes no endorsement, representations or warranties regarding any products or services provided by third party vendors such as Availity. Si tiene alguna pregunta acerca de los productos o servicios ofrecidos por estos proveedores, debe comunicarse con el proveedor directamente.