CommercialPrior AuthMedium impact
Prior Authorization Changes for Some Commercial Members
BCBS New Mexico·NM · Orthopedics, Physical Therapy, Sports Medicine +2 more·Prior Authorization
Effective date
Oct 1, 2026
We identified it
Jul 28, 2026
Summary
Blue Cross Blue Shield of New Mexico is removing prior authorization requirements for musculoskeletal codes previously reviewed by Carelon and select outpatient services codes previously reviewed by BCBSNM for some commercial members. Simultaneously, Alacura Medical Transportation Management will now handle utilization management review for medical transportation and related services. These changes take effect October 1, 2026.
Action Required
By September 15, 2026: Billing team must identify all musculoskeletal procedures and select outpatient service codes currently requiring prior authorization through Carelon or BCBSNM and remove these requirements from the billing system for BCBSNM commercial members. Update internal documentation and staff training to reflect that these services no longer require preservice review effective October 1, 2026. Contact BCBSNM for specific CPT/HCPCS code lists affected by the removal. For medical transportation services, update systems to route authorization requests to Alacura Medical Transportation Management instead of previous vendors. Verify eligibility and benefits through Availity Essentials before rendering services to confirm which utilization management vendor applies. Failure to comply may result in delayed claims processing or denials if prior authorization is obtained from incorrect vendors or if unnecessary authorizations are pursued.