Medicare AdvantagePrior AuthMedium impact
Prior Authorization Changes for Some Government Program Members
BCBS New Mexico·NM · Oncology, Radiation Oncology·Prior Authorization
Effective date
Jul 1, 2026
We identified it
Jun 18, 2026
Summary
BCBSNM is implementing prior authorization changes for government program members with staggered effective dates. Miscellaneous codes for Medicaid Turquoise Care will no longer require Carelon review starting July 1, 2026, and select Proton Beam codes for Medicare Advantage will be reviewed by BCBSNM starting October 1, 2026.
Action Required
Before July 1, 2026: Update billing system to remove Carelon prior authorization requirements for miscellaneous codes for Medicaid Turquoise Care members. Before October 1, 2026: Configure system to route select Proton Beam prior authorization requests to BCBSNM instead of Evicore for Medicare Advantage members. Always verify eligibility and prior auth requirements through Availity before rendering services.