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For Providers
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June 2025 |
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JUNE SPOTLIGHT |
Quality Measures Track Diabetes Care
Regular screenings, tests and office visits can help our members manage diabetes. Review tips on how to close care gaps.
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BEHAVIORAL HEALTH |
Review Claims Reminders for Behavioral Health Services
We monitor behavioral health claims for disallowed billing practices. See guidance on billing for services provided by trainees under supervision.
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Update: Watch for Changes to Behavioral Health Clinical Review Criteria for Substance Use
We’ll implement updates to the clinical criteria we use in medical necessity reviews of substance use services for adults.
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CLAIMS AND ELIGIBILITY |
Access BlueApprovRSM in Availity® Authorizations
The BlueApprovR utilization management tool will be integrated with Availity Authorizations in Availity Essentials. The new configuration will continue to expedite approvals for behavioral health services. Review how to submit and access prior authorization requests.
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NICU Claims Submissions Should Match Prior Authorization Levels of Care
Effective Aug. 1, 2025, we’ll pay claims based on the authorized level of neonatal intensive care units in your prior authorization.
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Review Prior Authorization Changes for Commercial Members
Effective July 1, 2025, prior authorization requirements for certain commercial plans are changing to reflect new, replaced or removed codes.
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NETWORK PARTICIPATION |
Providers with Unused Record IDs May Be Terminated from Networks
If you haven’t filed a claim with us under your record ID with a date of service within 24 months, we may cancel your record ID. Review how to keep record IDs active.
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Verify Your Directory Information Every 90 Days
Our members rely on our provider directory for accurate information about your practice. Review and verify your data every 90 days and update it when it changes.
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PHARMACY |
New Home Delivery Pharmacy Service to Fill Members’ Injectable GLP‑1 Prescriptions
Express Scripts® Pharmacy will transition home delivery prescriptions for covered, injectable GLP‑1 drugs to a new specialized pharmacy. Effective June 15, 2025, EnGuide Pharmacy will dispense these prescriptions. Learn what’s changing.
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Pharmacy Program Quarterly Update – Part 1
Changes were made to our drug lists and utilization management program. Learn about these and other pharmacy program updates.
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STANDARDS AND REQUIREMENTS |
Document Vaccines Administered in New Mexico
Providers are required to submit vaccine data to the New Mexico Statewide Immunization Information System as outlined in Senate Bill 58.
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Review New Coding Policy for Global Obstetrical Maternity Services
We have new coding guidance in our Clinical Payment and Coding Policy, CPCP044 Global Obstetrical/OB Maternity Services, effective Aug. 19, 2025.
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Learn About Updates to Clinical Payment and Coding Policies
We regularly add and modify our CPCPs as part of our ongoing policy review. See which policies were updated and when.
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Review 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. 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.
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TURQUOISE CARE |
Critical Incident Reporting Must Include Risk Level Entry
CIR portal submissions won’t be complete without risk level entries, according to the New Mexico Health Care Authority. Learn how this requirement impacts your reporting.
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Register for Medicaid Primary Care Payment Reform Workshops
The New Mexico Health Care Authority is offering in‑person trainings for their value‑based program.
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Learn About Contracting with Turquoise Care
If you’re interested in becoming a provider of Turquoise Care, call 505‑837‑8800 or 800‑567‑8540. Providers participating in our commercial products are not automatically participating providers in Turquoise Care.
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Contact Us
Contact information for Provider Network Representatives and other resources is on our website.
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Blue Cross and Blue Shield of New Mexico, a Division of Health Care Service Corporation, a Mutual Legal Reserve Company, an Independent Licensee of the Blue Cross and Blue Shield Association
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5701 Balloon Fiesta Pkwy NE, Albuquerque, NM 87113
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