January 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:

Prior Authorization Codes Updated, Effective January 1

As of Jan. 1, we’re changing prior authorization requirements that may apply for some commercial and Blue Cross Community Centennial^SM members to reflect new, replaced or removed Codes.

Current Procedural Terminology (CPT^®) Codes Updated for Prior Authorization for Medicare programs

As of Jan. 1, we’re changing prior authorization requirements that may apply for some Medicare members to reflect new, replaced or removed codes.

Cervical and Breast Cancer Screenings

The new year is an opportunity to remind our members to schedule screenings for cervical cancer and breast cancer. Regular screening tests can detect problems early when they’re easier to treat.

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:

Patients in the Qualified Medicare Beneficiary Program Should Not Be Billed

If you participate in Blue Cross Medicare Advantage plans, you may not bill our members enrolled in the Qualified Medicare Beneficiary program, a federal Medicare savings program.

Hospitals Must Provide Medicare Outpatient Observation Notice

Hospitals and Critical Access Hospitals are required to give the standardized Medicare Outpatient Observation Notice to our Blue Cross Medicare Advantage members who are under outpatient observation for more than 24 hours.

Centennial Care Behavioral Health Screening Incentive Program

BCBSNM implemented an incentive program for non-behavioral health providers to render behavioral health screenings to Blue Cross Community Centennial members. This program helps identify and measure the number of members with a behavioral health diagnosis.

Blue Cross Community Centennial Members Rate Their Experience

BCBSNM surveys on an annual basis its’ members on their experience with their providers and the health plan.

Our Blue Cross Community Centennial Quality Improvement Program

The primary goal of the BCBSNM Quality Improvement Program is to improve our members’ health status and outcomes. This is accomplished by deploying meaningful quality improvement activities and interventions that are implemented across all care settings.

Not Yet Contracted?

Providers who are participating in commercial BCBSNM products are not automatically participating providers in Blue Cross Community Centennial^SM. 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.