Blue Cross and Blue Shield of New Mexico

October 2016

Please distribute this newsletter, which contains claims, billing, Medical Policy, reimbursement, and other important information, to all health care providers, administrative staff, and billing departments/entities that this email address represents.
You can find Blue Review online!

Ideas for articles and letters to the editor are welcome; email

Do we have your correct information?
Maintaining up-to-date contact and practice information helps to ensure that you are receiving critical communications and efficient reimbursement processes. Additionally, the Centers for Medicare & Medicaid Services require Blue Cross and Blue Shield of New Mexico (BCBSNM) to make sure that our online Provider Finder® and provider directory are kept current with our provider demographic information. Please complete our quick and easy online form if you have:

  • Moved to another location
  • Left a group practice
  • Changed your phone number
  • Changed your email address
  • Retired
  • Any other changes to your practice information

Medical Policy Updates
Approved new or revised Medical Policies and their effective dates are usually posted on our website the first and fifteenth of each month. These policies may impact your reimbursement and your patients’ benefits. On our website, you may view active, pending and updated policies and/or view draft policies and provide comments. The policies are located under the Standards & Requirements tab at

Diabetes Blood Glucose Meter Program Updates for BCBSNM Members

BCBSNM offers certain blood glucose meters to members with diabetes at no additional charge to help them manage their condition. Members are limited to one glucose meter per year.

Effective Oct. 1, 2016, there are changes to the program with the types of products offered, as well as how members can obtain one of these meters. You are encouraged to share this updated program information with your patients. Members can access this updated program information from the member website. Or, for a direct link to the member flier, visit

Improving Coordination of Care for Our Members with Diabetes

In keeping with clinical practice guidelines,1 BCBSNM members diagnosed with diabetes should have an annual dilated, comprehensive eye exam performed by an ophthalmologist or optometrist to determine if the disease has caused damage to the eye. Diabetic changes in the eye, most commonly called retinopathy, which can lead to vision loss and blindness, is treatable. To help ensure members diagnosed with diabetes are receiving quality care, BCBSNM performs annual assessments through claims filed with BCBSNM and review of medical records data, as part of our goal to help improve continuity and coordination of care. View full story

New Prior Authorization Requirements for Blue Cross and Blue Shield of Nebraska Members
Blue Cross and Blue Shield of New Mexico (BCBSNM) is committed to providing recent news and updates to processes and requirements that may affect our participating providers and Bluecard® members.
View full story

Online Portal Applications Help Expedite Administrative Workflow
Does your office or organization ever ask, “Is this patient eligible for Blue Cross and Blue Shield New Mexico (BCBSNM) benefits?”, “Does this service require preauthorization?”, or ”How did my claim process?” These questions and many more can be answered with a few key strokes, in a matter of seconds using an online portal application, such as Availity™.
View full story

New Preauthorization Requirement for Applied Behavioral Analysis

Effective January 1, 2017, benefit preauthorization will be required for Applied Behavior Analysis (ABA) for the treatment of Autism Spectrum Disorder for eligible Blue Cross and Blue Shield of New Mexico (BCBSNM) members. Providers may request benefit preauthorization on behalf of members by calling the number on the member’s ID card. The call must be made at least one business day prior to the scheduling of the planned outpatient service. Our online benefit preauthorization tool iExchange® is not available for ABA preauthorization at this time.
View full story

New Benefit Preauthorization Requirements through eviCore
Effective Oct. 3, 2016, BCBSNM has contracted with eviCore healthcare (eviCore) to provide benefit preauthorization services for the new requirements. View full Story.

Office Staff

Claims inquiries? Call the Provider Service Unit (PSU) at 888-349-3706
Our PSU handles all provider inquiries about claims status, eligibility, benefits, and claims processing for BCBSNM members. For out-of-area claims inquiries, please call the BCBSNM BlueCard PSU at 800-222-7992.

Network Services Contacts and Related Service Areas

Network Services Regional Map

ICD-10 Code Updates Effective Oct. 1, 2016

ICD-10 Testing Through EDI

CMS issued an updated list of additional ICD-10 codes, effective Oct. 1, 2016. This update provides instructions to submitters on how to test the new ICD-10 claims through EDI.

View full story

Blue Cross Community CentennialSM (Medicaid)

Not yet contracted?

BCBSNM’s Medicaid plan is Blue Cross Community Centennial.

Providers who are participating in commercial BCBSNM products are not automatically participating providers in Blue Cross Community Centennial. To become a Blue Cross Community Centennial provider, you must sign a Medicaid amendment to your Medical Services Entity Agreement (MSEA).

If you have any questions, please call 505-837-8800 or 1-800-567-8540 if you are interested in becoming a Blue Cross Community Centennial provider.

Reminder: Update your Enrollment Information
Due to Centennial Care requirements, all enrollment information (changes to demographics, licensure or certification, provider status, etc.) must be updated on the NM Medicaid Provider Web Portal.

Medicaid Drug List Updates

Member Rights and Responsibilities
BCBSNM is committed to ensuring that enrolled members are treated in a manner that respects their rights as individuals entitled to receive health care services. BCBSNM is committed to cultural, linguistic and ethnic needs of our members. BCBSNM policies help address the issues of members participating in decision-making regarding their treatment; confidentiality of information; treatment of members with dignity, courtesy and a respect for privacy; and members’ responsibilities in the practitioner-patient relationship and the health care delivery process. View full story

What’s new with the Special Beginnings® Maternity Program?
Blue Cross Community Centennial members are able to take advantage of our maternity care coordination program, Special Beginnings. This program is supplemental to medical care – offering personal, confidential care coordination to pregnant members through their entire pregnancy. View full story

Hypertension Resources
According to the Centers for Disease Control, about 1 of 3 US adults have high blood pressure.¹
Blue Cross and Blue Shield of New Mexico (BCBSNM) offers resources for providers who manage Blue Cross Community Centennial patients with hypertension and related illnesses. View full story

Blue Cross Medicare AdvantageSM

Government Programs Upcoming Changes Affecting Claims Handling and Post-Adjudication Process, Effective Jan. 1, 2017

A number of upcoming changes will affect claims submissions for our Medicare Advantage Plans. These changes will assist in streamlining claims processing and improve efficiencies of claims routing to our primary claims adjudicator. View the full story to see the changes, effective January 1, 2017.

    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



Blue Cross and Blue Shield of New Mexico is committed to the highest standards of business ethics and integrity as well as strict observance and compliance with the laws and regulations governing its business operations.

A Division of Health Care Service Corporation, a Mutual Legal Reserve Company,
an Independent Licensee of the Blue Cross and Blue Shield Association.

P.O.Box 27630, Albuquerque, NM 87125-7630

© Copyright 2016. Health Care Service Corporation. All rights reserved.
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