COVID-19 Information for Providers

Please check the following Blue Cross and Blue Shield of New Mexico resources frequently for updates to important information related to COVID-19.

Updates made to the Provider Reference Manual

The BCBSNM Provider Reference Manual has been updated as part of an annual review, effective Jan. 1, 2024. Changes to the PRM include, but are not limited to, the following sections: 

The updated PRM is available on the Provider Reference Manual webpage. BCBSNM reminds providers to review the PRM for all changes. 

Chronic Kidney Disease Management Strategies for Primary Care Providers

BCBSNM invites primary care providers to an online learning series on chronic kidney disease management strategies. The courses offer continuing medical education credit at no cost to you.

Reimbursement Rate Update for Some Commercial ABA Codes

Effective Jan. 1, 2024, Blue Cross and Blue Shield of New Mexico will update the reimbursement rates for the ABA codes 0362T and 0373T.

The fee schedule will reflect the update for this code. This update applies to the following networks:

You may request an interactive copy of the fee schedule by following the steps on our Reimbursement Calculations page. Please contact your BCBSNM Provider Network Representative if you have any questions.

New Email Address for Electronic Commerce Services

The email address for BCBSNM Electronic Commerce Services has recently been updated to ecommerceservicesNM@bcbsnm.com.

Electronic Commerce Services is here to you assist with the following:

Please update your records with the new email address. For your convenience, inquiries sent to the previous Electronic Commerce Services email address will be forwarded to the new email address during this transition. Additionally, we are in the process of updating our provider website, forms, and provider manual with the new email address.

Not enrolled for 835 ERA and/or 835 EFT? Complete the online guided registration process via Availity^® Essentials. For more information, refer to the instructional EFT and ERA Enrollment User Guide on our provider website.

See Updates to Claim Editing Changes for Emergency Department Services

BCBSNM will enhance our claims editing and review process with Cotiviti for emergency department evaluation and management services for our commercial members. These editing enhancements for facility and professional claims will help ensure accurate billing and proper reimbursement.

Encourage Annual Eye Exams for Members with Diabetes

People with diabetes are at a higher risk of vision loss and eye diseases. Early diagnosis and proper treatment can greatly lower the chance of blindness from diabetic retinopathy. You may play an important role in supporting our members with diabetes by encouraging an annual retinal or dilated eye exam by an eye care specialist.

Clinical Payment and Coding Policy Updates

The Clinical Payment and Coding Policies on our website describe payment rules and methodologies for CPT, HCPCS and ICD-10 coding for claims submitted as covered services. This information is a resource for our payment policies. It is not intended to address all reimbursement-related issues. We regularly add and modify clinical payment and coding policy positions as part of our ongoing policy review process.

The following policies were updated:

Training Resources for Behavioral Health Care

More than 120 million Americans live in areas experiencing a shortage in behavioral health care providers. Even when providers are available, patients often rely on primary care physicians for behavioral health care. BCBSNM has compiled resources that providers across disciplines may find helpful to support patients presenting with behavioral health concerns.

Pharmacy Program Quarterly Update Changes Effective Jan. 1, 2024 — Part 1

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 Blue Cross and Blue Shield of New Mexico 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 Jan. 1, 2024.

Updates Made to the Blue Cross Medicare Advantage Provider Reference Manual

The Blue Cross Medicare Advantage Provider Reference Manual  has been updated as part of an annual review, effective Jan. 1, 2024. Changes to the PRM include, but are not limited to, the following sections: 

The updated PRM is available on the Provider Reference Manual webpage. BCBSNM reminds providers to review the PRM for all changes. 

Medical Records Reminder for Out-of-Area Medicare Advantage Members

If we need medical records for Blue Cross Group Medicare Advantage (PPO)^SM members, you will receive requests from BCBSNM or our vendor, Change Healthcare, as part of the Blue Cross and Blue Shield National Coordination of Care program. In addition, you may receive requests from EXL Health for select inpatient, diagnosis-related group claims for any out-of-area Blue Cross Medicare Advantage members.

Please respond promptly to our requests so that we may in turn provide timely service to those Medicare Advantage members.

Blue Cross Medicare Advantage Dual Care Plus^SM 2022 Program Summary

The Blue Cross Medicare Advantage Dual Care Plus program started Jan. 1, 2020. The Special Needs Plan continued in its form for a three-year period. The program serves older adults and people with disabilities.

Blue Cross Medicare Advantage Dual Care Plus Preferred 2022 Program Summary

The Blue Cross Medicare Advantage Dual Care Plus Preferred program started Jan. 1, 2022. The Special Needs Plan will continue in its current form for three years. The program serves older adults and people with disabilities.

Rate Increase for After Hours/Weekend Well Child Visits

Effective Nov. 15, 2023, BCBSNM is offering contracted providers a new revenue opportunity for Blue Cross Community Centennial members. Providers that are willing to expand their hours to accommodate help improve access to well child visits on weekends or after hours.

Updates Made to the Blue Cross Community Centennial Provider Reference Manual

The Blue Cross Community Centennial Provider Reference Manual has been updated as part of an annual review, effective Jan. 1, 2024. Changes to the PRM include, but are not limited to, the following sections: 

The updated PRM is available on the Provider Reference Manual webpage. BCBSNM reminds providers to review the PRM for all changes. 

BCBSNM Will Open a Blue Door Neighborhood Center in the South Valley

BCBSNM is proud to announce that we will be opening a Blue Door Neighborhood Center^SM in Albuquerque’s South Valley. The Center will offer members and the community access to in-person resources to improve their health and wellness at no cost.

BCBSNM Provider Engagement

Peter Crespin, BCBSNM Provider Relations Representative, presents at BCBSNM’s annual Medicaid provider training held in Albuquerque on Oct. 25.