Acquisition of Cigna Healthcare Medicare Business in 2025

No changes to member benefits will happen in 2025. More information about future changes will be communicated here. Read more details about the transaction.

Utilization Management Expanding to Include Site of Care Review of Advanced Imaging for Some Commercial Members

Effective Jan. 1, 2025, Carelon will review requests for authorization for some advanced imaging services in a hospital‑based outpatient setting. They will determine if a hospital setting is medically necessary and redirect the service to a freestanding alternative, if applicable.

Use the Updated Claims Referral Form for American Indian/Alaska Native Limited Cost-Share Plans

Faxing is no longer an option for pharmacy referrals, so we’ve updated the claims referral form that Indian Health, Tribal and Urban Indian providers use to refer members of limited cost‑sharing plans to non‑I/T/U providers.

Submit Paper Commercial Claims to Correct PO Box to Avoid Delays

We announced address changes last year for faster claims processing and responses. To avoid mail processing delays, submit paper commercial claims – including CMS‑1500 and UB‑04 forms – to the correct address.

ClaimsXten^TM Quarterly Update

We’ll implement fourth‑quarter code updates for the ClaimsXten auditing tool on or after Dec. 9, 2024.

Breast Cancer Screening Begins at Age 40

Routine screening for breast cancer is the best way to detect it early. Breast cancer screening for our members should begin at age 40 rather than age 50, in line with U.S. Preventive Services Task Force recommendations. Learn tips to close screening gaps in our members’ care.

In‑home Test Kits Help Our Members Manage Their Kidney Health

We’re providing in‑home urine albumin‑creatinine ratio test kits to certain eligible members who have diabetes. If you receive results for your patients, please document and discuss the results with them.

Register for a Coding Webinar on Coagulation Defects and Other Hematological Disorders

Join our Coding Compliance team for a webinar on coding and documentation for coagulation defects. The webinar is free for providers and coding professionals.

Clinical Payment and Coding Policy Updates

We regularly add and modify our Clinical Payment and Coding Policies as part of our ongoing policy review. Learn about the policies that were updated.

Medical Policy Updates

Approved new or revised medical policies and their effective dates are usually posted on our website the first and 15th of each month under the Standards and Requirements tab. You can view all active and pending policies, as well as draft medical policies, and provide comments on draft policies. These policies may impact your reimbursement and your patients’ benefits.

Provider Reference Manual Updates

Our Provider Reference Manual is updated, effective Nov. 1, 2024. Changes to the manual include, but are not limited to, the following section:

• 18 – Fraud and Abuse

The updated manual is available online. Please review it for all changes.

Health Care Authority Creates a Payment Reform for Primary Care Providers

Register by Oct. 14, 2024, for the updated Health Care Authority Primary Care Payment Reform Value‑Based Program for Medicaid primary care providers to maximize your quality bonus payments.

Learn About Contracting with Turquoise Care

Providers participating in commercial products of Blue Cross and Blue Shield of New Mexico are not automatically participating providers in Turquoise Care. If you’re interested in becoming a provider of Turquoise Care, call 505‑837‑8800 or 800‑567‑8540.

Reporting Requirements for Providers Supplying Diabetic Supplies, Equipment and Prescriptions

We’re required to monitor and report on the delivery of equipment, appliances, supplies, insulin and other prescription drugs to members in a timely manner as part of New Mexico House Bill 53.

BCBSNM Cuts Ribbon on Blue Door Neighborhood Center

We held a ribbon cutting ceremony in August for our Blue Door Neighborhood Center^SM in Albuquerque's South Valley. This center offers a place where people can learn, connect and improve their health.