CommercialPrior AuthMedium impact
Prior Authorization Changes for Some Commercial and Government Program Members, Effective April 1, 2026
BCBS New Mexico·NM · Psychiatry, Neurology·Prior Authorization
Effective date
Apr 1, 2026
We identified it
Jun 18, 2026
Summary
Blue Cross Blue Shield of New Mexico is removing prior authorization requirements for psychological/neuropsychological testing codes for commercial members and replacing revascularization codes reviewed by BCBSNM for Medicare Advantage members. Different utilization management vendors will handle reviews depending on member type.
Action Required
By April 1, 2026: Billing team must verify eligibility and benefits through Availity Essentials before rendering services to confirm current prior authorization requirements and which utilization management vendor applies (BCBSNM, Evicore, Carelon, or Alacura) based on member plan type. Update workflow to check member-specific requirements as psychological/neuropsychological testing no longer requires prior auth for commercial members.