Preauthorization and predetermination process All inpatient admissions and air ambulance requests require preauthorization except for emergency admissions. Preauthorizations can be called to 800-325-8334 or faxed using the Preauthorization Request form. Requests for benefit determination can be obtained by submitting a Predetermination Request form. You can also submit any supporting documentation with this form. Examples of predeterminations include: - Outpatient services
- Durable medical equipment
- Surgeries that might be considered cosmetic
- Possible experimental and investigational procedures
Predeterminations and preauthorizations will be accepted using either form and typically are processed within a five-day time period. Predetermination and preauthorization requests are reviewed by appropriate health service professionals. Note: This process excludes Federal Employee Program and BlueSaludSM members. Some groups may have selected additional prior authorization requirements. Health Services is available by phone at 800-325-8334 for any urgent requests or questions. You may also refer to: - The Claims & Eligibility section of our website and Section 10 of the Provider Reference Manual for more information about preauthorizations and predeterminations
- Section 12 of the Provider Reference Manual for behavioral health requirements
- The BlueSalud section of the Provider Reference Manual for Medicaid requirements
Blue Review • January 2012 • bcbsnm.com |