Introducing a New Prior Authorization Submission Tool via Availity^® Provider Portal

December 26, 2019

Blue Cross and Blue Shield of New Mexico (BCBSNM) is excited to introduce a brand-new online prior authorization application via the Availity Portal, called Authorizations (HIPAA-standard 278 transaction). This new and more convenient functionality will be available to providers as of Jan. 30, 2020, making it faster and easier to submit and receive confirmation from BCBSNM. For Federal Employee Program^® (FEP^®), providers should continue to use their current prior authorization process until this the new application becomes available in the near future.

What does this mean?

BCBSNM’s current electronic prior authorization tool, iExchange^®, will be deactivated on April 15, 2020, and all electronic prior authorization requests should be submitted using this new capability. This includes inpatient admissions, select outpatient services and behavioral health services handled by BCBSNM.

The process of submitting prior authorization requests to eviCore 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.

What should you do?

During the transition period, providers should migrate from iExchange to the new five-step Availity Authorization application. Providers not yet registered with Availity can sign up today at Availity, at no charge. For registration assistance call Availity Client Services at 800-282-4548.

Submitting online prior authorization requests using Availity’s Authorizations application is easy and consists of only five steps:

1. Log into Availity
2. Select Patient Registration menu option, choose Authorizations & Referrals, then Authorizations
3. Select Payer BCBSNM, then choose your organization
4. Select Inpatient Authorization or Outpatient Authorization
5. Review and submit your authorization

This new online option will increase administrative efficiencies for your organization by also allowing providers to:

• access and verify status of requests
• upload clinical medical records
• edit and/or extend requests
• obtain printable confirmation number for your records

Training

BCBSNM is hosting complimentary webinars for providers to learn how to use this new online prior authorization submission application. Simply click on your preferred date and time below to register

• Jan. 29, 2020 – 1 p.m. to 2 p.m.
• Jan. 30, 2020 – 8 a.m. to 9 a.m.
• Feb. 3, 2020 – 10 a.m. to 11 a.m.
• Feb. 4, 2020 – 2:30 p.m. to 3:30 p.m.
• Feb. 5, 2020 – 9:30 a.m. to 10:30 a.m.
• Feb. 6, 2020 – 2:30 p.m. to 3:30 p.m.

For More Information

Watch for the new Availity Authorizations & Referral tip sheets, coming soon to the Provider Tools section of our website.

If you need further assistance or customized training, contact our Provider Education Consultants.

^{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. Availity is a trademark of Availity, LLC, a separate company that operates a health information network to provide electronic information exchange services to medical professionals. Availity provides administrative services to BCBSNM. BCBSNM makes no endorsement, representations or warranties regarding any products or services provided by third party vendors such as eviCore and Availity. If you have any questions about the products or services provided by such vendors, you should contact the vendor(s) directly.}