October 2016

New Benefit Preauthorization Requirements through eviCore

Effective Oct. 3, 2016, BCBSNM has contracted with eviCore healthcare (eviCore) to provide benefit preauthorization services for the new requirements outlined below.

eviCore will manage benefit preauthorization for outpatient molecular and genetic tests and radiation oncology for dates of service beginning Oct. 3, 2016.

Services performed without preauthorization may be denied for payment, and the rendering provider may not seek reimbursement from members.

You will continue to use iExchange^® for all other services that require a referral and/or preauthorization.

Both BCBSNM and eviCore will be providing additional information, including training opportunities, in the coming months on the provider website and in the Blue Review. You may contact your Provider Network Representative for more information.

eviCore is an independent specialty medical benefits management company that provides utilization management services for BCBSNM.

Physicians, professional providers, facility and ancillary providers who are contracted/affiliated with an IPA/PHO must contact the IPA/PHO for questions and information regarding preauthorization requirements.

Please note that the fact that a service has been preauthorized/pre-certified 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.