April 2023

COVID‑19 Information for Providers

Please check the following Blue Cross and Blue Shield of New Mexico (BCBSNM) resources frequently for updates to important information related to COVID‑19:

AIM Specialty Health Changes Its Name to Carelon Medical Benefits Management

AIM Specialty Health^® (AIM) has changed its name to Carelon Medical Benefits Management (Carelon) effective March 1, 2023.

BCBSNM Engaged Hospital Service Corporation for Site Visits

Blue Cross and Blue Shield of New Mexico (BCBSNM) has engaged Hospital Service Corporation (HSC) to assist with site visits. HSC will be conducting pre-credentialing and other requested on-site provider office visits.

During these site visits, HSC may review certain practice’s policies, processes, and/or performance related to safety, care delivery and record keeping.

HSC will contact the practice to schedule an on-site visit during regular business hours. Prior notice will include information on the nature of the visit and what aspects of the site and/or care processes will be evaluated. Thank you in advance for your cooperation with HSC.

Please contact your assigned BCBSNM provider representative  if you have any questions or refer to the Provider Reference Manual for further information on site visits.

Earn Continuing Education Credit through Webinar on Opioids

Join us for a webinar, Synthetic Opioids and the Opioid Crisis.

See Changes to our Existing Inpatient Readmission Policy for Some Commercial Members

We’re updating our existing Clinical Payment and Coding Policy 027 following guidance from the Centers for Medicare & Medicaid Services (CMS).

Monitoring Children Using ADHD Medications

Attention-deficit/hyperactivity disorder (ADHD) is one of the most common behavioral health disorders affecting children, according to the Centers for Disease Control and Prevention (CDC). The National Committee for Quality Assurance (NCQA) recommends that pediatricians with prescribing authority monitor children using ADHD medication to ensure it is prescribed and managed correctly.

Caring for Substance Use Disorders

Providers can play an important role in talking with our members about the signs of substance use disorder and encouraging them to seek help, if appropriate. We’ve created resources for members that may help.

Screening and Follow-Up Care for Maternal Mental Health

Providers can help our members during and after pregnancy by screening for depression using a standard tool, such as the Patient Health Questionnaire (PHQ)-9 or -2. OB/GYNs and primary care physicians are encouraged to refer our members for follow-up care with a behavioral health care provider, when appropriate.

New for 2023: Specialty Pharmacies Added In-Network

We’ve expanded our specialty pharmacy network to include Christus Specialty Pharmacy, University Medical Center (UMC) and Red Chip. For our members with BCBSNM pharmacy coverage, these are new dispensing options for specialty medications covered under the pharmacy benefit.

Pharmacy Program Updates: Quarterly Pharmacy Changes Effective January 1, 2023 — Part 2

Based on the availability of new prescription medications and Prime’s National Pharmacy and Therapeutics Committee’s review of changes in the pharmaceuticals market, some additions or drugs moving to a lower out-of-pocket payment level, revisions (drugs still covered but moved to a higher out-of-pocket payment level) and/or exclusions (drugs no longer covered) were made to the BCBSNM drug lists. Your patient(s) may ask you about therapeutic or lower cost alternatives if their medication is affected by one of these changes.

View the Pharmacy Program Updates effective as of January 1, 2023 

Not Yet Contracted?

Providers who are participating in commercial BCBSNM products are not automatically participating providers in Blue Cross Community Centennial. If you are interested in becoming a Blue Cross Community Centennial provider, please call 505‑837‑8800 or 800‑567‑8540.

Reminder: Update your Enrollment Information

Due to Centennial Care requirements, all enrollment information (changes to demographics, licensure or certification, provider status, etc.) must be updated on the NM Medicaid Provider Web Portal .

BCBSNM Website

It’s important for you to stay informed about news that could affect your practice. BCBSNM offers many ways to stay informed via our website, bcbsnm.com/provider, and our provider newsletter, Blue Review. Signing up is easy.

Medical Policy Updates

Approved new or revised medical policies and their effective dates are usually posted on our website the 1st and 15th of each month. These policies may impact your reimbursement and your patients’ benefits. These policies are located under the Standards & Requirements tab at bcbsnm.com/provider.

Clinical Payment and Coding Policies

BCBSNM has adopted additional clinical payment and coding policies. These policies are based on criteria developed by specialized professional societies, national guidelines (e.g. Milliman Care Guidelines (MCG) and the CMS Provider Reimbursement Manual and are not intended to provide billing or coding advice but to serve as a reference for facilities and providers. These policies are located under the Standards & Requirements tab at bcbsnm.com/provider.

Claims Inquiries

Our Provider Service Unit (PSU) handles all provider inquiries about claims status, eligibility, benefits and claims processing for BCBSNM members. For the BCBSNM BlueCard^® PSU, call 800‑222‑7992. For out‑of‑area claims inquiries, call 888‑349‑3706.

Network Services Contacts and Related Service Areas

Verify Your Directory Details & Look for Reminders

Your directory information must be verified every 90 days under a new federal law. It’s easy and quick to get it done for all health plans in Availity^® , or if you prefer, you can use our Demographic Change Form. If we haven’t received your verification, look for emails and postcards from us with the checkmark symbol . They’re a friendly reminder that it›s time to verify or update.

Member Rights and Responsibilities

BCBSNM policies help address the issues of members participating in decision making regarding their treatment; confidentiality of information; treatment of members with dignity, courtesy and a respect for privacy; and members’ responsibilities in the practitioner‑patient relationship and the health care delivery process.