CommercialPrior AuthHigh impact
Prior Authorization Changes for Some Commercial and Government Program Members
BCBS New Mexico·NM · Oncology, Radiology, Diagnostic Imaging +2 more·Prior Authorization
Effective date
Apr 1, 2026
We identified it
Jun 18, 2026
Summary
Blue Cross Blue Shield of New Mexico is implementing significant prior authorization changes across multiple service areas including oncology, advanced imaging, sleep medicine, and genetic testing. Different review organizations (Carelon, Evicore, BCBSNM) will handle prior authorizations for different member types, with changes rolling out in phases from April 1, 2026 through July 1, 2026.
Action Required
By March 31, 2026: Billing team must update prior authorization workflows to route requests to correct review organizations - Carelon for commercial oncology/imaging/sleep/genetic codes, Evicore for Medicare Advantage, BCBSNM for drug codes and Medicare orthotic/pharmacy codes. Update eligibility verification process through Availity Essentials to confirm which vendor handles each service. Train staff on new Part B Step Therapy Program for Medicare Advantage starting July 1, 2026. Services without required prior authorization may be denied and providers cannot bill patients.