Blue Cross Medicare Advantage Prior Authorization Updates effective Sept. 1, 2020

July 30, 2020

On Sept. 1, 2020, Blue Cross and Blue Shield of New Mexico (BCBSNM) will update its list of Blue Cross Medicare Advantage Prior Authorization Procedure Codes to comply with the American Medical Association (AMA). These changes are the result of new, replaced or removed codes implemented by the AMA.

What’s New: Providers will need to utilize the new list of procedure codes on the Blue Cross Medicare Advantage^SM Plans web page under the Prior Authorizations Requirement section when determining if a service requires prior authorization Sept. 1, 2020, and after. You can also use Availity^® or your preferred vendor for prior authorization requirements.

Check Eligibility and Benefits: Prior to rendering services, providers should use Availity or your preferred vendor to check eligibility and benefits to confirm membership, check coverage, determine if you are in-network for the member's policy and determine whether prior authorization is required. Availity allows prior authorization determination by procedure code and providers can submit requests on Availity using the Authorization & Referral tool. Refer to the BCBSNM Eligibility and Benefits page for more information on Availity. Payment may be denied if you perform procedures without authorization. If this happens, you may not bill your patients.

More Information: Check the AMA website  for more information on CPT codes. If you have questions, contact Provider Customer Service.

^{CPT copyright 2019 American Medical Association (AMA). All rights reserved. CPT is a registered trademark of the AMA.}

^{eviCore is an independent specialty medical benefits management company that provides utilization management services for BCBSNM.}

^{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.}

^{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.}

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