Addition of New Prior Authorization Requirements for Blue Cross Community Centennial^SM Members

July 30, 2020

There are important changes to the prior authorization requirements for Blue Cross Community Centennial Members.

Beginning September 1, 2020, the following changes will be made to the Blue Cross Community Centennial Prior Authorization Grid:

Code	Prior Authorization Source	Change	Effective Date
63688	BCBSNM	remove	9/1/2020
C9024	BCBSNM	remove	9/1/2020
C9028	BCBSNM	remove	9/1/2020
C9030	BCBSNM	remove	9/1/2020
C9032	BCBSNM	remove	9/1/2020
C9467	BCBSNM	remove	9/1/2020
C9492	BCBSNM	remove	9/1/2020
C9493	BCBSNM	remove	9/1/2020
C9016	BCBSNM	remove	9/1/2020
C9466	BCBSNM	remove	9/1/2020
97124	BCBSNM	remove	9/1/2020

Code	Prior Authorization Source	Change	Effective Date
0153U	eviCore	add	9/1/2020
0156U	eviCore	add	9/1/2020
0157U	eviCore	add	9/1/2020
0158U	eviCore	add	9/1/2020
0159U	eviCore	add	9/1/2020
0160U	eviCore	add	9/1/2020
0161U	eviCore	add	9/1/2020
0162U	eviCore	add	9/1/2020
0169U	eviCore	add	9/1/2020
0170U	eviCore	add	9/1/2020
0171U	eviCore	add	9/1/2020
81277	eviCore	add	9/1/2020
81307	eviCore	add	9/1/2020
81308	eviCore	add	9/1/2020
81522	eviCore	add	9/1/2020
81542	eviCore	add	9/1/2020
81552	eviCore	add	9/1/2020
97124	BCBS	remove	9/1/2020
77399	eviCore	remove	9/1/2020
63688	BCBS	remove	9/1/2020
C9024	BCBS	remove	9/1/2020
C9028	BCBS	remove	9/1/2020
C9030	BCBS	remove	9/1/2020
C9032	BCBS	remove	9/1/2020
C9467	BCBS	remove	9/1/2020
C9492	BCBS	remove	9/1/2020
C9493	BCBS	remove	9/1/2020
C9016	BCBS	remove	9/1/2020
C9466	BCBSNM	remove	9/1/2020
76873	eviCore	remove	9/1/2020
76965	eviCore	remove	9/1/2020
77261	eviCore	remove	9/1/2020
77262	eviCore	remove	9/1/2020
77263	eviCore	remove	9/1/2020
77280	eviCore	remove	9/1/2020
77285	eviCore	remove	9/1/2020
77290	eviCore	remove	9/1/2020
77293	eviCore	remove	9/1/2020
77295	eviCore	remove	9/1/2020
77299	eviCore	remove	9/1/2020
77300	eviCore	remove	9/1/2020
77301	eviCore	remove	9/1/2020
77306	eviCore	remove	9/1/2020
77307	eviCore	remove	9/1/2020
77316	eviCore	remove	9/1/2020
77317	eviCore	remove	9/1/2020
77318	eviCore	remove	9/1/2020
77321	eviCore	remove	9/1/2020
77331	eviCore	remove	9/1/2020
77332	eviCore	remove	9/1/2020
77333	eviCore	remove	9/1/2020
77334	eviCore	remove	9/1/2020
77336	eviCore	remove	9/1/2020
77338	eviCore	remove	9/1/2020
77370	eviCore	remove	9/1/2020
77417	eviCore	remove	9/1/2020
77427	eviCore	remove	9/1/2020
77431	eviCore	remove	9/1/2020
77432	eviCore	remove	9/1/2020
77435	eviCore	remove	9/1/2020
77469	eviCore	remove	9/1/2020
77470	eviCore	remove	9/1/2020
77499	eviCore	remove	9/1/2020
77789	eviCore	remove	9/1/2020
77790	eviCore	remove	9/1/2020
77799	eviCore	remove	9/1/2020
81200	eviCore	remove	9/1/2020
81205	eviCore	remove	9/1/2020
81507	eviCore	remove	9/1/2020
C9408	eviCore	remove	9/1/2020
0104U	eviCore	add	9/1/2020
0036U	eviCore	add	9/1/2020
81362	eviCore	add	9/1/2020
81322	eviCore	add	9/1/2020
81293	eviCore	add	9/1/2020
81289	eviCore	add	9/1/2020
A9590	eviCore	add	9/1/2020
0172U	eviCore	add	9/1/2020
0173U	eviCore	add	9/1/2020
0175U	eviCore	add	9/1/2020
0179U	eviCore	add	9/1/2020

It is important to use Availity®, or your preferred vendor, to check eligibility and benefits, determine if you are in-network for your patient, and whether any pre-authorization or pre-notification is required. Availity allows you to determine if pre-authorization is required. Refer to the Eligibility and Benefits web page for more information on Availity. Providers can also refer to the Prior Authorization section Blue Cross Community Centennial web page for more information regarding prior authorizations.

Such services are funded in part with the state of New Mexico.

As a reminder, it is important to check eligibility and benefits prior to rendering services. This step will help you determine if benefits prior to authorization is required for a particular member. For additional information, such as definitions and links to helpful resources, refer to the Eligibility and Benefits section on BCBSNM's provider website.

Please note that verification of eligibility and benefits, and/or the fact that a service or treatment has been pre-authorized or pre-determined for benefits is not a guarantee of payment. Benefits will be determined once a claim is received and will be based upon, among other things,the member's eligibility and the terms of the member's certificate of coverage applicable on the date services were rendered. If you have questions, contact the number on the member's ID card.

Availity is a trademark of Availity, L.L.C., 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 offered by Availity, or Medecision. The vendors are solely responsible for the products or services they offer. If you have any questions regarding any of the products or services they offer, you should contact the vendor(s) directly.

Addition of New Prior Authorization Requirements for Blue Cross Community CentennialSM Members

Addition of New Prior Authorization Requirements for Blue Cross Community Centennial^SM Members