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.

Reminder: Update Your Records with New Mailing Addresses for Paper Claims

We announced new mailing addresses in September for faster claims processing and responses. If you haven’t yet updated your records, make note of the addresses below for paper claims.

Updates made to the Provider Reference Manual

The BCBSNM Provider Reference Manual been updated, effective Feb. 3, 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. 

Advisory on Telemedicine Services — Using Place of Service Codes on Commercial Claims

What’s Changing: We’re updating our telemedicine commercial claims filing guidelines following recommendations from the Centers for Medicare & Medicaid Services .

When filing commercial claims, follow these place of service (POS) code recommendations from CMS:

The above POS code changes designate where the patient is located when receiving services through telemedicine.

This notification applies to claims for commercial BCBSNM members.

More Information: Continue to visit the News and Updates page on the provider website and the Blue Review newsletter for further updates regarding telemedicine. Visit the CMS website  for more information on modifications to the POS codes for telemedicine.

Prior Authorization Updates

We’re changing prior authorization requirements that may apply for some commercial members to reflect new, replaced or removed codes.

Three New ClaimsXten^TM Rules to be Implemented March 2024

On or after March 1, 2024, we will update the ClaimsXten software database to better align coding with the reimbursement of claim submissions.

Reminder: 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.

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:

Monitoring Children Using ADHD Medication

Providers who prescribe ADHD medication to children should monitor them to ensure medications are managed correctly, according to the National Committee for Quality Assurance.

Remind Our Members about Cervical and Breast Cancer Screenings

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

Oral Oncology Pharmacy Network Transitioned to IntegratedRx^TM

As of Oct. 1, 2023, the Prime Therapeutics^® oral oncology pharmacy network has transitioned to the IntegratedRx network of specialty pharmacies.

BCBSNM’s Approach to Managing GLP-1 Agonist Medications

BCBSNM is committed to providing its members access to safe, appropriate, and cost-effective health care within their plan benefits. To ensure the appropriate use of GLP-1s as indicated for diabetes, we are making it easier for some of our members with diabetes to bypass our prior authorization process.

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 Feb. 3, 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. 

Prior Authorization Updates for Medicare

We’re changing prior authorization requirements that may apply for some Medicare members to reflect new, replaced or removed codes.

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.

Update Your Records: New Medicare Open Access PPO Members and ID Cards

New Medicare-eligible retirees have joined our Blue Cross Group Medicare Advantage Open Access (PPO)^SM plans for retirees of employer groups and Blue Cross Medicare Advantage Flex (PPO)^SM plan for individuals. These are open access, national PPO plans without network restrictions.

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 Feb. 3, 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. 

Zuni Youth Enrichment Project Receives Grant from BCBSNM to Improve Health Outcomes for Zuni Residents

Zuni Youth Enrichment Project announced it recently received a $20,000 grant from BCBSNM’s Blue Impact^SM initiative. The grant will allow Zuni Youth Enrichment Project to increase community wide trail access and improve health outcomes for Zuni residents.

BCBSNM Provider Engagement

BCBSNM attended the Head to Toe Conference last November in Albuquerque. From left, Emily Dold RN, BCBSNM Clinical Practice Consultant, Andrea Ewing, BCBSNM Provider Relations Representative, Consuelo Bolagh-Cowder, BCBSNM Community Outreach Specialist, Winona Gishal, Community Outreach Specialist and Patricia Chavez, Unit Manager Provider Relations.