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For Providers
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September 2025 |
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SEPTEMBER SPOTLIGHT |
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Avoid Antibiotics for Acute Bronchitis and Other Viruses
Antibiotics don’t work against viruses and can cause side effects and antimicrobial resistance. Learn about a Centers for Disease Control and Prevention event on Sept. 16, 2025, on antibiotics awareness.
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CLAIMS AND ELIGIBILITY |
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Watch for Claim Editing Changes for Emergency Department Services for Medicaid
Effective Nov. 1, 2025, we’ll enhance our claims editing and review process for emergency department evaluation and management services for our members with Turquoise Care.
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Review New Claims Editing Rules
We’re updating the Lyric software database in November 2025 to better align coding with claim reimbursements. See what’s changing.
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Continue to Use Fee Schedules from 2024
As we’re working to enhance our fee schedule structure, the fee schedules that were updated last year will remain in effect until further notice.
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CLINICAL RESOURCES |
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Use Shared Decision‑Making Aids to 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.
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EDUCATION |
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Explore Learning Opportunities
We offer free training for providers who participate in our networks. Review and sign up for sessions, including a behavioral health webinar on medication for opioid use disorder.
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NETWORK PARTICIPATION |
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Watch for Updated Out‑of‑area Member ID Cards Without Suitcase Logo
Some Blue Cross and Blue Shields Plans have begun updating their member ID cards to remove the suitcase logo. Learn about the change.
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PHARMACY |
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See 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 |
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Learn About Updates to Clinical Payment and Coding Policies
We regularly add and modify 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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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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