BlueApprovR is an online tool accessible in Availity Essentials that allows providers to submit inpatient and/or outpatient prior authorization requests for medical/surgical, specialty pharmacy drugs, and behavioral health services, as well as recommended clinical review requests for medical/surgical and specialty pharmacy drugs for many commercial members.
BlueApprovR is designed to help simplify the provider submission process by asking for the information to support a medical necessity determination.
Registered Availity Essentials users have free, 24/7 access to BlueApprovR tool to:
- Secure real-time approvals for certain services and begin treatment right away
- Easily attach medical records
- Check approval status and view history of your request
Use BlueApprovR to request prior authorization for these types of care:
- Specialty Pharmacy
- Behavioral Health
- Inpatient Acute Care
- Long-term Acute Care
- Inpatient Rehab
- Skilled Nursing Facility
- Outpatient Hospice
- Inpatient Hospice
- Home Health
- Outpatient Service
How to Access BlueApprovR:
1. Log into Availity Essentials
2. Select Payer Spaces from the navigation menu and choose BCBSNM
3. Within Payer Spaces, select the Applications tab and click BlueApprovR
4. Users will be redirected to BlueApprovR to complete the request online
Resources and Support:
- See our quick overview on the value of using BlueApprovR
- Refer to the BlueApprovR User Guide to learn how to access and use BlueApprovR via Availity Essentials.
- The BlueApprovR Behavioral Health User Guide assists with requesting initial behavioral health prior authorization requests, concurrent review, revision of the end date, and patient discharge instructions.
- For additional education, training and technical assistance with this tool, contact the BlueApprovR Support Team.
Note: This tool is currently not available for Medicare Advantage, New Mexico Medicaid or Federal Employee Program® members. Please use your existing process for requesting prior authorization for these members.
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.