At Blue Cross and Blue Shield of New Mexico (BCBSNM), we are committed to fast and efficient claim processing. In order to prevent delays, billing errors and other potential setbacks, we’ve put together valuable tips and information to help you manage and submit claims.
This section identifies the policies and procedures for dispute resolution that providers have a contractual obligation to follow. Here is a list of operational issues that may be identified as areas of concern for providers participating with BCBSNM:
• Disputes regarding claims
• Determination of medical necessity
• Contract issues, including contractual language, reimbursement, termination, and credentialing/quality issues
• Quality of care issues
• Potential cases of fraud
In a continuing effort to reduce administrative costs and improve claim turnaround, BCBSNM requires complete CMS-1500 information on all claims, including National Provider Identifier. Incomplete claim forms will be returned to you for required information. Learn more
BCBSNM strongly encourages the electronic submission of claims. Claims may be submitted electronically 24 hours a day, seven days a week. All BCBSNM facility (UB04) and professional (CMS-1500) claims (excluding adjustments) can be filed electronically at no charge through the Availity® Health Information Network.
The electronic payer ID for BCBSNM is 00790 and is recognized by most clearinghouses in order to route electronic claims to BCBSNM. All electronic claims submitted to BCBSNM must be routed with payer ID 00790. You may need to contact your clearinghouse if they use a different BCBSNM payer ID.
For more information about submitting claims, refer to Section 8 , Claims Submission in our Provider Reference Manual. For any Electronic Funds Transfer (EFT) and Electronic Remittance Advice (ERA) questions refer to the EFT/ERA web page.
Taxonomy codes are administrative codes set for identifying the provider type and area of specialization for health care providers. Each taxonomy code is a unique ten character alphanumeric code that enables providers to identify their specialty at the claim level. Taxonomy codes are assigned at both the individual provider and organizational provider level. Learn More
The BCBSNM contract requires providers to initially submit accurate, complete claims within 180 days of the date of service; see contract page 4, Article II.B.3. If an original claim is submitted after the 180-day limit, it is denied for timely filing.
Refer to Section 8 of the Blues Provider Reference Manual to find out more about submitting claims, acceptable proof of timely filing and more. Learn More
Upon a recent review of claim denials, we have identified the most common issues that can cause delays in claims processing. These are a few tips to keep in mind when filing claims. Learn More