Medicare AdvantagePrior AuthHigh impact
Update: Prior Authorization Changes for Medicare Advantage Members, Effective Jan. 1, 2026
BCBS New Mexico·NM · Radiology, Orthopedics, PM&R (Physical Medicine & Rehab) +3 more·Prior Authorization
Effective date
Jan 1, 2026
We identified it
Jun 18, 2026
Summary
Effective January 1, 2026, Blue Cross Blue Shield of New Mexico is taking over prior authorization reviews for Medicare Advantage members in five categories that were previously handled by EviCore healthcare. All prior authorization requests for advanced imaging, musculoskeletal care, sleep medicine, medical specialty drugs, and genetic testing must now be submitted directly to BCBSNM instead of EviCore.
Action Required
Immediately: Update billing workflows to submit prior authorization requests for Medicare Advantage members to BCBSNM instead of EviCore for advanced imaging, musculoskeletal procedures, sleep studies, medical specialty drugs, and genetic testing. Train staff to use Availity Essentials to verify which utilization management vendor to use for each request. Update prior authorization checklists and EMR templates to reflect the new submission process.