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.

BCBSNM Receives Notification of Intent to Award Turquoise Care Contract

We are pleased to announce that the New Mexico Human Services Department (HSD) has notified BCBSNM of HSD’s intent to award BCBSNM with a Turquoise Care contract for 2024. BCBSNM has served our Medicaid members since 2008.

“We are proud to continue serving our Medicaid members,” said Janice Torrez, BCBSNM president. “We have a longstanding commitment to increasing access to high-quality, cost-effective, equitable health care in our state, which includes addressing critical health needs and social determinants of health. We’re proud to provide innovative programs and services to help improve health outcomes and reduce disparities for New Mexico’s Medicaid population.“

Read the full HSD press release here .

New Mailing Addresses for Paper Claims

We’re updating our mailing addresses for faster claims processing. Electronic claim submission is preferred, but if you need to submit paper claims, use our new addresses.

Updates made to the Provider Reference Manual

The BCBSNM Provider Reference Manual (PRM) has been updated as part of an annual review, effective November 4, 2023. 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. 

ClaimsXten^TM Quarterly Update Effective Dec. 4, 2023

BCBSNM will implement its fourth quarter code updates for the ClaimsXten auditing tool on or after Dec. 4, 2023.

Inpatient DRG claims for patients transferred early will be paid according to CMS’ transfer policy

Effective Nov. 20, 2023, BCBSNM will have the functionality to follow the Centers for Medicare and Medicaid Services’ (CMS) transfer rules when paying inpatient claims that use the Medicare Severity Diagnostic Related Group (DRG) claims methodology.

Reminder for Billing Point-Of-Use Convenience Kits

BCBSNM regularly reviews claims submitted by providers to help ensure that benefits provided are for services that are included in our member’s benefit plan and meet our guidelines. Some providers are submitting claims for point-of-use convenience kits used in the administration of injectable medicines. In addition to the injectable medicine, these prepackaged kits include supply items, such as alcohol prep pads, cotton balls, disposable sterile medical gloves, povidone-iodine swabs, adhesive bandages and gauze. As a reminder, only the drug component of the kit is reimbursable to the provider.

BCBSNM periodically checks the pricing of these kits to manage costs. Often, the cost of these convenience kits is more than the cost of its components when purchased one item at a time. These non-drug supplies are considered as part of the practice expense for the procedure performed and no added compensation is warranted. Reimbursement for these point-of-use convenience kits may be updated based upon the FDA-approved drug component.

Remember to provide the most appropriate care in the most cost-effective manner.

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:

Updates to Clinical Practice and Preventive Care Guidelines

We’ve updated our Clinical Practice Guidelines and Preventive Care Guidelines. The guidelines draw from evidence-based standards of care and nationally recognized medical authorities. They help direct our quality and health management programs and improve member care. They may help guide your decision-making as you care for our members.

We update them no less than every two years or when new significant findings or major advancements in evidence-based care are established.

BlueApprovR^SM Now Accepts Recommended Clinical Reviews — 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 (RCR) for some medical and surgical and specialty pharmacy drugs for many of our commercial members.

Supporting Quality Care During Breast Cancer Awareness Month

Routine screening for breast cancer is the best way to detect it early, according to the Centers for Disease Control and Prevention. Breast cancer is easier to treat when it’s caught earlier. October is Breast Cancer Awareness Month and a good time to remind our members about the importance of regular screenings for women. We’ve created resources that may help.

See New Enhancements for Behavioral Health Pre-service Reviews

BCBSNM is continuing to make improvements to its Behavioral Health pre-service request and review process for some commercial members.

Select Medication List to be Discontinued

Effective Dec. 1, 2023, the Select Medication List will be removed from our Provider website. The list included specific medications eligible for increased reimbursement over similar medications within the same drug class, when billed with the appropriate National Drug Code pricing information. This pricing differential will be discontinued on Dec. 1, 2023.

Reimbursement rates for these and all other specialty medications will continue to be updated monthly, as applicable. Contracted providers may continue to obtain the Reimbursement Schedule by emailing feeschedulerequests@bcbsnm.com. Please add “Request for Maximum Allowable Fee Schedule” in the subject line and include your tax ID number within the body of the email message.

Updates Made to the Blue Cross Medicare Advantage Provider Reference Manual

The Blue Cross Medicare Advantage Provider Reference Manual  (PRM) has been updated as part of an annual review, effective November 4, 2023. Changes to the PRM include, but are not limited to, the following section: 

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

Current Procedural Terminology (CPT^®) Codes Updated for Prior Authorization for Medicare Oct. 1

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

Survey Assesses Medicare Advantage Members’ Health Outcomes

The Centers for Medicare & Medicaid Services (CMS) sends a Health Outcomes Survey (HOS) to a sample of our members from August through November. The survey asks members in Blue Cross Medicare Advantage^SM and prescription drug plans to rate their last six months of care.

If you get questions from members who have received the survey, please encourage them to respond. The survey covers health care topics our members may discuss with you, such as:

HOS results identify opportunities to improve health care plans. Results also affect the CMS Star Ratings , which rate Medicare Advantage plans on a scale from one to five stars. Our goal is to achieve the highest possible Star rating for our plans.

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 November 4, 2023. Changes to the PRM include, but are not limited to, the following section:

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

Blue Cross and Blue Shield of New Mexico Awarded NCQA Long-Term Services and Support Distinction

BCBSNM has recently been awarded a Long-Term Services and Supports (LTSS) Distinction by the National Committee for Quality Assurance (NCQA). The NCQA is a private, nonprofit organization dedicated to improving health care quality.

BCBSNM Provider Engagement

BCBSNM’s annual meeting with the business office managers of Albuquerque Area Indian Health Service on Sept. 8, 2023. From left, LaDonna Valdo, ACL Service Unit, Tricia MacLaughlin, BCBSNM Sr. Provider Relations Representative and Ardie Lowden, ACL Service Unit.