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BCBS New MexicoMedicaid · Prior Auth · Prior Authorization · NMHigh impact

Learn About Enhancements to Medicaid Utilization Management Process, Effective Sept. 18, 2026

Act
by Sep 18, 2026
Effective date
Sep 18, 2026
Identified
Aug 15, 2026

Summary

Blue Cross Blue Shield of New Mexico is launching Medicaid Authorizations, a new real-time prior authorization submission and management tool within Availity Essentials effective September 18, 2026. This replaces manual processes and allows providers to check authorization requirements, submit requests, upload documentation, and track status 24/7 through a streamlined digital workflow.

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What to do

by Sep 18, 2026 · 7 steps
01Billing and clinical teams must complete mandatory training on Medicaid Authorizations through Availity Essentials.
02Register for one of four available webinars (Sept 14-17, 2026).
03Update all prior authorization workflows to use the new Medicaid Authorizations portal accessed via Availity Authorizations & Referrals by selecting 'Turquoise Care' as the payer.
04Modify internal procedures to submit all New Mexico Medicaid prior authorization requests through this new system instead of phone, fax, or mail.
05Train front desk, clinical, and billing staff on the new member search, eligibility verification, and real-time authorization determination features.
06Update encounter templates and routing to leverage the 24/7 submission capability and concurrent review options.
07Document the new workflow in compliance protocols.
If missed: Failure to transition by the effective date may result in delayed authorization determinations and potential claim denials.

Original notice

Learn About Enhancements to Medicaid Utilization Management Process, Effective Sept. 18, 2026
bcbsnm.com · Always check the source before changing claims.
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