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