Preauthorization
For an overview of the preauthorization process at Blue Cross and Blue Shield of New Mexico (BCBSNM), refer to Section 10 
of the Blues Provider Reference Manual .
Section 10.1 – Preauthorization Process Overview
- Information needed by Health Services to complete preauthorization process
- Health Services preauthorization process highlights
Section 10.2 – Services Requiring Preauthorization or Predetermination
Provides a listing of those services that require preauthorization or predetermination through the BCBSNM Health Services Department (if covered by the member's plan), except in an emergency
Sections 10.3 and 10.4 – Emergency and Urgent care
Provides information regarding Emergency and Urgent care
Section 10.5 – Radiology Quality Initiative (RQI) Program
- Preauthorization requirements for certain imaging services
- RQI preauthorization process
- OptiNet Assessment Tool
View the most common codes that require medical review for preauthorization or predetermination
For behavioral health services, call 888-898-0070 for authorizations, benefits, and eligibility information. Refer to Section 12, Behavioral Health Services , of the Blues Provider Reference Manual.
If you have any questions, please contact the Health Care Services Department at
800-325-8334.
