Providers can check prior authorization requirements for procedure codes online by using Availity Essentials Eligibility and Benefits. If you aren’t able to check online, our IVR phone system has a new menu option to quickly confirm prior authorization requirements for procedure codes for our commercial members.
With this option, you can proceed directly to checking prior authorization requirements without speaking to customer service.
How to use it: When you call the customer service number on our members’ ID cards, follow the prompts to “Check Procedure Code Requirements.” Refer to the updated Check Authorization by Procedure Code IVR Caller Guide for more details.
Learn more about prior authorization. Need IVR help? Email our Provider Education Consultants.
This information does not apply to Blue Cross Medicare Advantage members.
Checking eligibility and/or benefit information and/or obtaining prior authorization 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, including, but not limited to, exclusions and limitations applicable on the date services were rendered. Certain employer groups may require prior authorization or pre-notification through other vendors. If you have any questions, call the number on the member's ID card. Regardless of any prior authorization or benefit determination, the final decision regarding any treatment or service is between the patient and the health care provider.
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 Blue Cross and Blue Shield of New Mexico. BCBSNM makes no endorsement, representations or warranties regarding third party vendors and the products and services they offer.