June 2017  

Online Enrollment Options in Availity^TM

Blue Cross and Blue Shield of New Mexico (BCBSNM) offers you multiple enrollment opportunities for electronic options through the Availity Web portal, in addition to supporting utilization of standard administrative transactions through Availity or your preferred vendor portal. Instead of faxing or mailing paper enrollment forms, you may complete the online enrollment options listed below through Availity, at no cost. In addition, Availity provides single sign-on access to several online tools, including those highlighted below. This feature offers you greater convenience and security, without the need for another User ID and password.

Electronic Fund Transfer (EFT) and Electronic Remittance Advice (ERA)
BCBSNM-contracted providers* may enroll online for EFT and ERA and also make any necessary set-up changes in Availity. The online enrollment process can be completed in near real-time. Providers will receive a confirmation letter acknowledging the enrollment effective date and related information. Once an organization is enrolled for ERA, providers and billing services also gain access to the Availity Remittance Viewer. This online tool permits users to search, view, save and print remittance information, even if the ERA is delivered to an appointed receiver.

*This excludes atypical providers who have not acquired a National Provider Identifier (NPI).

Benefit Preauthorization – iExchange^® (Single sign-on access)
Once you are registered as an Availity user, you may enroll through the Availity Web portal for iExchange. This tool supports online submission and electronic approval of benefits for inpatient admissions, as well as select outpatient and clinical pharmacy services. iExchange also offers you an alternative to calling to request status of most benefit preauthorization requests. Additionally, iExchange accepts electronic medical record documentation for predetermination of benefits requests. As a reminder, always check eligibility and benefits first to find out if benefit preauthorization is required for a particular member. Please note that, for behavioral health services, you should continue to use the current fax and telephone benefit preauthorization methods.

Electronic Refund Management (eRM) (Single sign-on access)
Registered Availity users also have the opportunity to gain access to eRM, an online tool that helps simplify the overpayment reconciliation process. You will receive electronic notification of overpayments, with the option to deduct from a future payment or pay by check. eRM also permits users access to the Claim Inquiry Resolution (CIR) tool, a method of online assistance that helps save your staff time by reducing the amount of calls and specific written inquiries on finalized claims. The eRM and CIR tools are not available for government programs claims.

Learn more…
To learn more about these and other electronic tools and resources, visit the Education and Reference Center/Provider Tools section of our website at bcbsnm.com/provider. Also see the Training page for dates, times and registration for online training sessions on a variety of topics. For assistance or customized training, contact a BCBSNM Provider Education Consultant at PECS@bcbsnm.com.   

Not yet registered with Availity? Visit availity.com and complete the online application today. If you need registration assistance, contact Availity Client Services at 800-AVAILITY (282-4548).

Checking eligibility and/or benefit information and/or the fact that a service has been preauthorized 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 back of 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. iExchange is a trademark of Medecision, Inc., a separate company that offers collaborative health care management solutions for payers and providers. BCBSNM makes no endorsement, representations or warranties regarding any products or services offered by third party vendors such as Availity or Medecision. If you have any questions about the products or services offered by such vendors, you should contact the vendor(s) directly.

Blue Cross^®, Blue Shield^® and the Cross and Shield Symbols are registered service marks of the Blue Cross and Blue Shield Association, an association of independent Blue Cross and Blue Shield Plans.