Extending Prior Authorization on Previously Approved Elective Surgeries, Procedures and Therapies
Blue Cross and Blue Shield of New Mexico (BCBSNM) is temporarily extending approvals on services with existing prior authorizations until Dec. 31, 2020. This applies to services that were originally approved or scheduled between Jan. 1 and April 1, 2020. This is for most non-emergent, elective surgeries, procedures, therapies and home visits.
What’s new: A member may reschedule an approved procedure to a later date within 2020 without a new prior authorization. This applies only to current members for a benefit that is covered under their plan at the time services are rendered.
BCBSNM will honor all prior authorizations on non-emergent surgeries, procedures, therapies and home visits approved or scheduled between Jan. 1 and April 1, 2020.
These prior authorizations are approved through Dec. 31, 2020, so approved procedures can be rescheduled before Dec. 31, 2020.
Therapy sessions and home visits authorized for a specific number of occurrences between Jan. 1 and April 1, 2020, will have the same number of occurrences available through the end of the year.
These rules apply to current members for a benefit that is currently covered under their plan.
Impacted members: This applies to all group, fully insured, self-funded, retail and Medicare Advantage members.
Medicaid and MMAI plans’ prior authorization will be extended according to those plan rules.
Additional services or sessions: For additional services or sessions, providers must submit a new prior authorization request.