June 2017

Blue Cross and Blue Shield of New Mexico Managed Care Program Blue Cross Community Centennial Changes, Effective May 20, 2017

To help improve efficiencies in routing, handling and post-adjudication processes for the Blue Cross and Blue Shield of New Mexico (BCBSNM) Blue Cross Community Centennial program, changes impacting electronic transactions and claim submissions will be implemented on May 20, 2017. Blue Cross Community Centennial members are identified by alpha-prefix YIF listed on their BCBSNM identification card.

As of May 20, 2017, the payer ID for Blue Cross Community Centennial Professional and Institutional electronic claims will change. Blue Cross Community Centennial Professional and Institutional electronic claims must be submitted using the new payer ID, MC721. If these claims are submitted via direct data entry through the Availity™ Web portal, providers should utilize the drop down payer option of “Blue Cross Community Centennial.”

The below table outlines claim submission requirements that will apply to claims submitted for Blue Cross Community Centennial members. Providers may receive claim rejections if the following information is missing or incorrect on these submissions.

Blue Cross Community Centennial Claim Submission Requirements	Electronic Claim Loops and Segments
Billing Provider Taxonomy Code is required on all claims. (excludes Atypical Providers)	2000A, PRV03
Billing Provider Address is required on all claims. This should contain the physical address and not a P.O. Box or Lock Box.	2010AA, N301/N302
Billing Provider NPI is required on all claims. (excludes Atypical Providers)	2010AA, NM109
Rendering Provider Taxonomy Code is required on Professional claims when the Rendering Provider information is submitted at the claim and/or service line level.	2310B, PRV03 (claim level) 2420A, PRV03 (service line level)

Rendering Provider NPI is required on Professional claims when the Rendering Provider is different from the Billing Provider.

2310B, NM109 (claim level)
2420A, NM109 (service line level)

Present on Admission Indicator is required on Institutional claims when the Type of Bill equals 11X, 12X, 21X, 22X, 65X, 66X, 69X or 89X AND the Principal or External Cause of Injury Diagnosis code is present.

(excludes Acute Care Hospitals)

2300, HI01-9

National Drug Code must be an 11-digit value when present on Professional claims.

2410, LIN03

Providers may receive rejections if a Blue Cross Community Centennial member claim is submitted with the BCBSNM commercial payer ID of 00790, instead of MC721. For assistance, refer to the rejection and resolution example below.

Note: The following rejection message may slightly differ for your claim clearinghouses and/or vendors.

If you receive claim rejections due to the submission lacking an above requirement, the affected claims must be resubmitted with the necessary information.

Previously, Availity users verified eligibility and benefit inquiries for Blue Cross Community Centennial members using the drop down payer option of “BCBSNM Medicaid.” Starting June 17 2017, when utilizing the Availity Eligibility and Benefit Inquiry (270) or Claim Status Inquiry (276) for these members, the correct drop down payer option to select will be “Blue Cross Community Centennial.”

If you have any questions or need additional information, please contact your Provider Network Representative. Our Provider Network Representatives are available to assist you Monday – Friday, 8 a.m. to 4 p.m. MST, locally (505) 837-8800 or toll-free (800) 567-8540.

Checking eligibility and/or benefit information is not a guarantee of payment. Benefits will be determined once a claim is received and will be based upon, among other things, the member’s eligibility and the terms of the member’s certificate of coverage applicable on the date services were rendered. If you have any questions, please call the number on the member’s ID card.

Availity is a trademark of Availity, LLC, a separate company that operates a health information network to provide electronic information exchange services to medical professionals. Availity provides administrative services to BCBSNM. BCBSNM makes no endorsement, representations or warranties regarding any products or services offered by third party vendors such as Availity. If you have any questions about the products or services offered by such vendors, you should contact the vendor(s) directly.

Such services are funded in part with the State of New Mexico.
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