- Electronic Commerce
- Interactive Voice Response (IVR)
- Refund and Recoupment
- Provider Website tour
Visit our Provider Training page for more information and to register. If you have questions, please email us.
Radiology Quality Initiative (RQI) program to include new cardiac services
Effective Jan. 1, 2014, Blue Cross and Blue Shield of New Mexico (BCBSNM) is expanding the RQI, administered by AIM Specialty Health® (AIM), to include certain additional cardiac services.
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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
Automated phone system fax back options
We recommend utilizing an online vendor portal such as Availity® (availity.com) to obtain eligibility, benefit, and claim status information. However, some practices may have limited Internet access, or may feel a phone call is more convenient at times.
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Pharmacy program transitions to electronic prior authorization (PA) process
Blue Cross and Blue Shield of New Mexico (BCBSNM) is transitioning to a new electronic process for submission of PA requests for drugs that are part of our PA program. In addition to reducing paper, the electronic PA process will help increase security of your patient’s protected health information. It is also faster—your office will receive a response in real time upon receipt and processing of each online PA request. Watch for more details in the Blue Review and News and Updates section of our website at bcbsnm.com/provider.
ClaimsXtenTM enhanced C3 screen
Effective on or after October 14, 2013, Blue Cross and Blue Shield of New Mexico (BCBSNM) will enhance the Web-based code auditing reference tool, Clear Claim ConnectionTM (C3). This is available to registered users of Availity or RealMed®. The changes include the addition of the following fields:
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Providers who have joined or left the BCBSNM network, August 2013
This list reflects contracted providers for all lines of BCBSNM business: Commercial and Medicaid managed care (BlueSaludSM).
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BlueSaludSM and Blue Cross community CentennialSM
Not yet contracted for BlueSalud? What about Centennial Care?
Providers who are participating in commercial BCBSNM products are not automatically participating providers in BlueSalud. To become a BlueSalud provider, you must sign a Medicaid amendment to your Medical Services Entity Agreement (MSEA).
BlueSalud is effective through December 31, 2013. Beginning January 1, 2014, BCBSNM will continue with the new State of New Mexico Medicaid program, Centennial Care. BCBSNM’s Medicaid plan for 2014 is Blue Cross Community CentennialSM. A New Mexico Medicaid Managed Care Amendment was mailed to BCBSNM participating providers for review. To begin treating BCBSNM’s future Medicaid managed care members on and after January 1, 2014, we ask that you please sign and return the amendment (or you may fax the entire amendment to 505-816-2688).
After the signed amendment has been received, it will be executed by BCBSNM and a signed copy will be returned to your office, with an effective date of January 1, 2014. If you have any questions, please call 505-837-8800 or 1-800-567-8540
Centennial Care Pharmacy
Providers will experience some pharmacy-related enhancements under Centennial Care:
- BlueSalud will become Blue Cross Community Centennial.
- Providers will be able to submit preauthorization requests to BCBSNM electronically and receive a response electronically.
- A single, standardized pharmacy preauthorization form will be used by all Centennial Care Managed Care Organizations (MCOs).
- The Blue Cross Community Centennial Drug List will be expanded to provide additional therapeutic options.
- Drugs will be covered under a single plan. Pharmacies will no longer need to submit behavioral health prescriptions from behavioral health providers to a different plan for payment.
Please watch upcoming issues of the Blue Review as well as the News and Updates section of our Provider website at bcbsnm.com/provider for additional information on pharmacy enhancements.
Services are funded in part under a contract with the State of New Mexico.
Blue Cross and Blue Shield of New Mexico refers to HCSC Insurance Services Company (HISC), which is a wholly owned subsidiary of Health Care Service Corporation (HCSC), a Mutual Legal Reserve Company. Both HISC and HCSC are Independent Licensees of the Blue Cross and Blue Shield Association.