The Availity provider engagement portal helps providers and Blue Cross and Blue Shield of New Mexico (BCBSNM) to securely share information easily and efficiently. Using Availity allows you to quickly verify patient eligibility and benefits, confirm prior authorization requirements, submit prior authorization requests, check claim status, obtain provider claim summaries, and more without having to call BCBSNM.
Advantages of using Availity
- Accessible 24/7
- HIPAA Compliant
- Multi-Payer Solution
- Real-time Search Results
- No Cost Transactions
- Printable Results
- Online Help Features
Electronic Provider Tools
The following complimentary self-service tools are accessible through Availity and can be used to accomplish multiple tasks and gain information.
Pre-Service Tools |
Descripción |
|---|---|
Eligibility and Benefits Inquiry |
verify real-time patient activity, check coverage details and determine prior authorization requirements |
Patient Care Summary |
consolidated view of a patient's health care history |
Patient Cost Estimator* |
estimate a patient's potential out-of-pocket costs |
Patient ID Finder* |
obtain the BCBSNM patient ID and group number |
Attachments* |
submit predetermination of benefits requests handled by BCBSNM |
Authorizations |
submit prior authorization requests handled by BCBSNM |
Altruista Health's GuidingCareTM (single sign-on access) |
monitor rendered services, activities, quality measures and care plans for Blue Cross Community CentennialSM members |
Post-Service Tools |
Descripción |
Estado de la reclamación |
check detailed, real-time claim status |
Research Procedure Code Edits (Clear Claim Connection)* |
determine how coding combinations on a specific claim may be evaluated during the adjudication process |
Reporting On-Demand |
view, download, save and/or print the Provider Claim Summary (PCS) for finalized claims |
Remittance Viewer |
offers providers and billing services a convenient way to view and help reconcile claim data in the 835 Electronic Remittance Advice (ERA) |
Electronic Refund Management (eRM)* |
reconcile claim overpayments and manage refund requests |
Claim Inquiry Resolution (CIR)* |
submit claim reconsideration request for certain finalized claims |
Medical Attachment |
receive and electronically respond to medical record requests for quality and risk adjustment |
Clinical Quality Validation (CQV) |
comply with Healthcare Effectiveness Data and Information Set (HEIDIS) measures by electronically documenting the patient's care and assessment |
*Not available for Medicare Advantage members.
If you have not yet registered for Availity 
, you can sign up today at no charge. For registration assistance, you may contact Availity Client Services at 800-282-4548.
Para Más Información
Refer to the Capacitación page to register for upcoming online training sessions.
Have additional questions or need customized training? Email our Provider Education Consultants for assistance.
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 any 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. GuidingCare is a trademark of Altruista Health., a separate company that offers collaborative health care management solutions for payers and providers. BCBSNM makes no endorsement, representations or warranties regarding any products or services provided by third-party vendors such as Availity and GuidingCare. Si tiene alguna pregunta acerca de los productos o servicios ofrecidos por estos proveedores, debe comunicarse con el proveedor directamente.
ClaimsXten and Clear Claim Connection are trademarks of Change Healthcare, an independent company providing coding software to BCBSM. Change Healthcare is solely responsible for the software and all the contents. Contact the vendor directly with any questions about the products, software and services they provide.