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.

Provider Finder^® to Highlight ‘Top Performing Physicians’

In early 2024, our Provider Finder tool will identify providers who are highly rated for quality, cost-efficient care and appropriate treatment plans. These providers’ profiles will display a “Top Performing Physician” designation to help inform our members and connect them with care.

Join Us for a Webinar on Coding for Vascular Disease

Join our Coding Compliance team for a webinar on coding and guidelines for vascular disease. The webinar is free to providers and coding professionals.

New CPT^® Codes for COVID-19 Vaccines and Vaccine Administration

The American Medical Association has updated its COVID-19 vaccine coding guidance. It released six new Current Procedural Terminology codes for Pfizer’s and Moderna’s vaccines and their administration.

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:

Coordinating Care after Hospital Discharges to Help Reduce the Chances of Readmissions

When our members receive inpatient hospital care, it’s important for hospital care teams to share information with primary care providers to coordinate care after discharge.

What You Need to Know About the Flu Season

The Centers for Disease Control and Prevention recommends yearly flu vaccines for persons 6 months and older without vaccine contraindication. Providers may administer any U.S. Food and Drug Administration approved, age‑appropriate flu vaccine.

Remember: New Enhancements for Behavioral Health Preservice Review Requests

Just a reminder that BCBSNM is making enhancements to its Behavioral Health preservice request and review process for some commercial members.

Read our previous article for more detail on these enhancements. Continue to watch News and Updates for more information on Behavioral Health.

BlueApprovR^SM Now Accepts Recommended Clinical Reviews for Behavioral Health — Attend a Training

BCBSNM continues to streamline the pre-service review process to reduce your workload with BlueApprovR. This tool, accessible in Availity^® Essentials, now processes optional recommended clinical reviews for behavioral health, medical and surgical services and specialty pharmacy drugs for many of our commercial members.

Pharmacy Program Updates: Quarterly Pharmacy Changes Effective Oct. 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 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 Oct. 1, 2023.

Musculoskeletal Category Expansion, Code Removals and other Prior Authorization Updates, Effective Jan. 1, 2024

Effective Jan. 1, 2024, we’re changing prior authorization requirements that may apply for some ASO commercial and/or Medicaid Blue Cross Community Centennial^SM members to reflect new, replaced or removed codes.

Medical Oncology, Radiation Oncology Care Category Removal from eviCore and other Prior Authorization Updates for Medicare Jan. 1

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

Medicare Advantage Members to Transition to BCBSNM Kidney Care Program

In January 2024 we’re launching a specialized care coordination program for eligible Blue Cross Medicare Advantage (PPO)^SM and Blue Cross Medicare Advantage (HMO)^SM members who have chronic or end-stage kidney disease. Our Kidney Care Program will replace the Somatus kidney care program, a service currently provided by vendor Somatus, Inc.^®.

RSVP for 2023 Annual Medicaid Provider Training Sessions

BCBSNM is offering in-person and virtual provider training sessions for Blue Cross Community Centennial network behavioral health, long-term care and physical health providers and groups.

BCBSNM Will Implement a New Process for Member-Driven PCS Hour Decreases

Effective Nov. 7, 2023, BCBSNM will implement a new process when a member requests a decrease in their current approved personal care service hours.

Temporary Economic Recovery Payment Increase for Home and Community Based Services — LOD #79-1

The New Mexico Human Services Department has issued Letter of Direction #79-1 effective September 27, 2023. This LOD directs Managed Care Organizations to implement a temporary economic recovery payment rate increase of five and ten percent reimbursement for specific Home and Community Based Services.

Expiration of the Public Health Emergency — Prior Authorization for ABA Services

Effective Oct. 1, 2023, BCBSNM will end flexibilities for prior authorizations for applied behavior analysis services allowed during the Public Health Emergency PHE.

Blue Cross and Blue Shield of New Mexico Teams Up With National Fitness Campaign to Bring Outdoor Fitness Courts Across New Mexico

BCBSNM is proud to announce a partnership with the National Fitness Campaign to bring free, outdoor Fitness Courts^® to communities across New Mexico. The courts will increase access to fitness and reduce barriers to accessing physical activity.

BCBSNM Provider Engagement

BCBSNM attended Synchrony’s annual Health Information Exchange Users’ Conference on Oct. 5 and 6.
From left, Michael Archuleta, BCBSNM Sr. Director Quality & Accreditation, Nichole McClung, BCBSNM Quality Management Specialist, Lisa Goodman BCBSNM Provider Relations Representative and Consuelo Bolagh-Cowder, BCBSNM Community Outreach Specialist.