Medicare AdvantagePrior AuthHigh impact
Changes to Our Prior Authorization Programs for Medicare Advantage
BCBS New Mexico·NM · Radiology, Orthopedics, Sleep Medicine +1 more·Prior Authorization
Effective date
Jan 1, 2026
We identified it
Jun 18, 2026
Summary
Effective January 1, 2026, BCBSNM Medicare Advantage prior authorization requests for Advanced Imaging, Musculoskeletal, Sleep Medicine, Specialty Drugs, and Genetic Testing must now be submitted to BCBSNM instead of EviCore. The change reduces prior authorization requirements to fewer than 20% of codes and excludes Proton Beam Therapy which remains with EviCore.
Action Required
Immediately: Billing team must update prior authorization submission process to send requests to BCBSNM instead of EviCore for Medicare Advantage members requiring Advanced Imaging, Musculoskeletal, Sleep Medicine, Specialty Drugs, and Genetic Testing services. Verify member eligibility and prior auth requirements through Availity Essentials or member ID card before submitting. Update staff training on new workflow. Continue sending Proton Beam Therapy requests to EviCore.