Availity's Authorizations tool (HIPAA-standard 278 transaction) allows providers to electronically submit prior authorization requests for inpatient admissions and select outpatient services handled by BCBSNM. Providers can also check status on previously submitted requests and/or update applicable existing requests.
Benefits of using this online functionality:
- No separate user enrollment needed
- Direct access within Availity portal
- Simplified 4-step process
How to access and use Availity Authorizations:
- Log in to Availity
- Select Patient Registration menu option, choose Authorizations & Referrals, then Authorizations
- Select Payer BCBSNM, then choose your organization
- Select a Request Type and start request
- Review and submit your request
For additional details, refer to the Availity Authorizations User Guide.
Important Tips:
- Check eligibility and benefits online first to determine if preauthorization is required for the service and/or procedure code(s). Learn more on using Availity for Eligibility and Benefits.
- Authorizations managed by Carelon Medical Benefits Management (formerly known as AIM Specialty Health) are handled through the Carelon Medical Benefits Management provider portal.
- Authorizations managed through eviCore® healthcare (eviCore) will continue to be handled through the eviCore portal.
- For Recommended Clinical Review requests:
- Submit via Availity Attachments tool by completing and uploading the appropriate form. Learn how to submit electronically by referring to the Availity Attachments: Submit Recommended Clinical Review Requests page.
- You can also use BlueApprovR via single sign-on access from Availity to submit recommended clinical review (RCR) requests for some inpatient and/or outpatient, medical and surgical and specialty pharmacy drugs for many BCBSNM commercial members.
- If you do not have Availity access, you may fax or mail the appropriate form in the Forms section.
Providers who are not yet registered with Availity, can sign up today at Availity, at no charge. If you need registration assistance, contact Availity Client Services at 800-282-4548.
Questions?
Email our Provider Education Consultants. Be sure to include your name, direct contact information, Tax ID and/or Billing NPI.
Checking eligibility and/or benefit information 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 any questions, please call the number on the member's ID card.
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 third party vendors and the products and services they offer.
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. BCBSNM makes no endorsement, representations or warranties regarding third party vendors and the products and services they offer.
Carelon Medical Benefits Management (formerly known as AIM Specialty Health) is an independent medical benefits management company that provides utilization management services for BCBSNM. BCBSNM makes no endorsement, representations or warranties regarding third party vendors and the products and services they offer.