- Medicare/Other Insurance EOB
- Duplicate Denial
- Additional Information
- Corrected Claim
- Fee Schedule/Pricing Inquiry
To help you navigate this helpful tool, view our CIR Tip Sheet. If you have questions or need assistance, email our Provider Access Channel Specialist team.
*You must be enrolled for eRM in order to gain access to the CIR tool. CIR may not be accessed through our Customer Advocates on the phone. CIR cannot be used to obtain eligibility and benefit information, claim status, claim appeal, predeterminations, or pended claims. Please refer to the CIR Tip Sheet for additional details.
Providers who have joined or left the BCBSNM network, February, 2012
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.
Call Network Services at 800-567-8540 or (505) 837-8800 to make demographic changes, check new contract status, obtain existing contract copies, make changes to an existing contract (e.g., business name or tax ID), or to terminate an existing contract.
Network Services contacts and related service areas
Network Services regional map
Billing IV infusion and injection procedures
We appreciate your ongoing endeavors to file complete and accurate claims with BCBSNM, which is vitally important for all stakeholders in the member, provider, and managed health plan relationship.
When providing IV infusions and injections, it is crucial that your claims include the CPT® or HCPCS code for the procedure, along with the applicable National Drug Code (NDC) for each J code for the drugs which have been infused and injected (and a detailed description of the drug(s) if the generic code J9999 is used).
By omitting the proper codes, you deny yourself potential reimbursement for the drug(s) to which you may otherwise be entitled. You also deny BCBSNM the opportunity to determine whether the infusion or injection is within your scope of practice and whether it is experimental, investigational, medically necessary, in conformance with BCBSNM medical policy, and otherwise a covered benefit for the member.
If IV infusions and/or injections are billed without the NDC for each J code, BCBSNM reserves the right to request such information from you before the claim is released for adjudication. If the requested information is not provided, the claim may be denied.
We sincerely appreciate and value your continued participation with BCBSNM. If you have any questions, please contact your Provider Representative at (505) 837-8800 or 800-567-8540.
Importance of advance directives
Advance directives (AD) allow competent individuals to direct and document their preferences about future health care treatments and interventions. The Patient Self-Determination Act of 1991 requires that individuals be advised of their right to participate in health care decisions as well as their right to execute advance directives.
Ideally, the discussion about AD should occur when an individual is healthy, which makes the primary care office an ideal setting for AD discussion. While studies have shown that primary care providers (PCPs) think that discussing AD will make their patients uncomfortable, studies have also shown that PCP initiation of advance care planning discussions has a positive effect on patients completing AD.
Inquiring about or presenting this topic to each new patient can provide a systematic approach for addressing advance care planning and AD. In addition, this information can be revisited with each patient annually to ensure there are no changes.
The New Mexico Administrative Code (NMAC) 8.305.8.17 states that managed care organizations shall enforce that Medicaid contracted providers document advanced directive information for all adult patients. For your convenience, the BlueSalud Provider Reference Manual has a New Mexico Optional Advance Health Care Directive Form that you and your patients may use to document AD (see page 67 of the Provider Reference Manual PDF).
If you have any questions about AD, please contact Nicole Casados, RN, at (505) 816-2238.
Updates to the BlueSalud Drug List
Ideas for articles and letters to the editor are welcome; e-mail NM_Blue_Review_Editor@bcbsnm.com.
BCBSNM makes no endorsements, representations, or warranties about any products or services offered by independent third-party vendors mentioned in this newsletter. The vendors are solely responsible for the products or services offered by them. If you have any questions about the products or services mentioned in this newsletter, contact the vendor directly.