![]() To be covered by the member’s Blue Cross Community Centennial health plan, all services to be furnished by out-of-network providers must be prior authorized by BCBSNM, in addition to meeting all other conditions of coverage. Providers may not seek payment from the member when a claim is denied for lack of a prior authorization number. Note: Medical necessity must be determined before an authorization number will be issued.Ĭlaims received that do not have a prior authorization number will be denied. Prior authorizations can be obtained by calling the BCBSNM Medicaid program number at 1-877- 232-5518 or with the NM Uniform Prior Authorization Form. Authorizations are based on benefits as well as medical necessity, which are supported through clinical information supplied by requesting physicians. Unless otherwise prohibited by law, prior authorizations are required for certain services before they are rendered.
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