Physician Performance Insights Reports Are Now Available

PPI reports are available for physicians who are eligible for our Physician Efficiency, Appropriateness, & Quality^SM program. Learn what the reports include on performance and how the ratings can help our members find care.

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.

Shared Decision‑Making Aids Can Help Guide Care Choices

Our members may have better patient experiences and outcomes when they participate in their care. Learn about evidence‑based aids that can help involve your patients.

Earn Continuing Education Credit at Maternal Mental Health Webinar

On Sept. 9, 2024, we’re offering a free webinar on maternal mental health from 8 to 9 a.m. MT. Register here  and learn more about our behavioral health webinars.

Register for Webinars on Coding for Cancers, Stroke and Heart Failure

Join our Coding Compliance team for webinars in September and October on coding and documentation. The webinars are free to providers and coding professionals, and have tips on closing gaps in care.

Encourage Medicare Members to Respond to Health Outcomes Survey

The Centers for Medicare & Medicaid Services sends a survey to a sample of our members to rate their care. Learn about the survey topics our members may discuss with you.

Facility‑Based Providers Have a Credentialing Requirement

All contracted providers must be credentialed with us to be listed in our directory. This includes providers based at facilities who haven’t previously been credentialed.

Abiraterone Drug Coverage Changes for Many Commercial Members as of Oct. 1, 2024

Starting Oct. 1, 2024, coverage of abiraterone acetate will change for many of our commercial members with pharmacy benefits administered by Prime Therapeutics. These members will only have coverage for the CivicaScript^®‑produced, low‑cost generic version of abiraterone acetate 250 mg.

30‑Day Supply Limit: Select Commercial Members Have New Pharmacy Benefit for GLP‑1 or Anti‑Obesity Drug Therapy

This optional pharmacy benefit program is available to some employer groups with Prime Therapeutics. Learn how it aims to reduce drug waste.

Pharmacy Program Quarterly Update Changes Effective Oct. 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, revisions (drugs still covered but moved to a higher out‑of‑pocket payment level) and/or exclusions (drugs no longer covered) were made to our drug lists.

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. These policies may impact your reimbursement and your patients’ benefits.

Keep Your Enrollment Status with New Mexico Medicaid Updated

Medicaid providers should ensure that their enrollment status with New Mexico Medicaid is up to date on the New Mexico Medicaid Portal . Failure to comply with these requirements may result in termination from the New Mexico Medicaid program and denial of claims.

New EPSDT Clinical Practice and Billing Guideline Is Available

The Clinical Practice and Billing Guideline for Early and Periodic Screening, Diagnostic and Treatment services emphasizes preventive health and uniform delivery for improved health outcomes.

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.

Employees Provide Needed Supplies to New Mexico Students

Our employees donated more than $6,000 in supplies to schools through Operation Back to School. This employee‑driven initiative provides the supplies students need to excel in the classroom.