Reminder: Use New Mailing Address

We announced new mailing addresses in September for faster claims processing and responses. Starting Oct. 1, 2024, mail sent to our previous addresses will be forwarded through the postal service to our new addresses. This will result in delays to claims processing and payment.

Important Updates to Manage My Organization in Availity^® Essentials

Updates have been made to Manage My Organization in Availity Essentials to improve security and ensure your organization’s provider information remains current.

New Mexico House Bill 27: Breast Exam Health Coverage

New Mexico House Bill 27 applies to coverage issued or renewed on or after Jan. 1, 2024. This bill prohibits cost sharing on covered diagnostic and supplemental breast exams that are medically necessary and clinically appropriate.

Electronic Claim Review and Ensuring the Correct Use of our Claim Review Form

Effective Aug. 1, 2024, we’ll return any incomplete form without conducting the claim review.

ClaimsXten^TM Quarterly Update Effective Aug. 19, 2024

Blue Cross and Blue Shield of New Mexico will implement its third quarter code updates for the ClaimsXten auditing tool on or after Aug. 19, 2024.

Helping Our Members Manage Diabetes

You may play an important role in supporting our members with diabetes through regular screenings, tests and office visits. We track several quality measures from the National Committee for Quality Assurance related to diabetes care.

Updated PEAQ^SM Methodology Is Now Available

The updated methodology for our Physician Efficiency, Appropriateness, and Quality^SM program is now available on our PEAQ page. The methodology explains how PEAQ evaluates physician performance.

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:

Behavioral Health Consultations During Hospitalization Can Improve Outcomes

Behavioral health consultations during a hospital stay can help our members who have physical and behavioral health conditions. We encourage hospital staff/attending providers to consider consultations and follow-up care coordination when appropriate.

Pharmacy Program Quarterly Update Changes Effective July 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 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 July 1, 2024 .

Closing Gaps in Care for Group Medicare Advantage (PPO) Members

If we need medical records for Blue Cross Group Medicare Advantage (PPO)^SM members, you will receive requests from BCBSNM or our vendor, Advantmed, 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 members of Blue Cross Medicare Advantage.

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

RSVP for the 2024 Turquoise Care Provider Training Sessions

BCBSNM is offering in-person and virtual Turquoise Care training sessions for behavioral health, long term care and physical health providers in June.

Medicaid Transition to Turquoise Care on July 1, 2024

BCBSNM and the New Mexico Human Services Department are preparing for the transition to Turquoise Care.

Turquoise Care Provider Reference Manual

The Turquoise Care Provider Reference Manual is now available, effective July 1, 2024.

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

Helping New Mothers at Home

Many Mothers’ Maternal Support Home Visiting Program was recently awarded a $20,000 grant by Blue Impact^SM to help provide no-cost, in-home support to new mothers and other caregivers shortly after their baby is born.