• What are the most commonly used provider forms and their uses?
• How do I become a BCBSNM provider?
• What does the BlueSalud member ID card look like?
• Whom do I contact if I have questions about the BlueSalud network?
• How do I automate my electronic claims payments?
• Whom do I contact if I have questions about claims, contracts, or preauthorization?
• How do I change my existing provider record information?
• How do I get an NPI?
• How do I participate in the Blue Medicare PPO network?
• Is the Blue Review newsletter distributed electronically?
• How can I avoid claim payment delays?
What are the most commonly used provider forms and their uses?
The eight most commonly used provider forms and their uses are:
- Coordination of Benefits Questionnaire
- Provider Refund Form
- Provider Request for Appeal on Behalf of a Member
- Provider Request for Claim Review
- Request to Establish or Revise a Facility Record
- Request to Establish or Revise a Provider Record
- Rx Drug PrimeMail Fax Form (must be faxed from a physician's office)
- Rx Drug Prior Authorization Form
How do I become a BCBSNM provider?
Fill out a Professional or Facility application for participation.
Mail the application and the requested documentation to:
BCBSNM
Attn: Network Services (HQ-3)
P.O. Box 27630
Albuquerque, NM 87125-7630
For more information, go to Become a BCBSNM Provider.
What does the BlueSalud member ID card look like?
A sample BlueSalud member ID card is available by going to BlueSalud, then Resources.
Whom do I contact if I have questions about the BlueSalud network?
For questions about the BlueSalud network, call Angela Sanchez-Caldwell at 505-816-2038.
How do I automate my electronic claims payments?
Complete the HCSC Electronic Funds Transfer Agreement and the HCSC Electronic Funds Transfer Agreement Instructions.
Send the completed forms to:
Health Care Service Corporation
Electronic Commerce Services Unit - 25th Floor
300 East Randolph Street
Chicago, Illinois, 60601
Please see ERA/EFT FAQs in Electronic Commerce for answers about electronic claims filing.
Whom do I contact if I have questions about claims, contracts, or preauthorization?
Go to Contact Us on the Provider homepage.
How do I change my existing provider record information?
You can use the forms Request to Establish or Revise a Facility Record or Request to Establish or Revise a Provider Record located in the Forms section of the Provider Library, or you can use the Update Your Contact Information icon on the Provider homepage.
1. Apply online
2. Apply by mail. Call or email the NPI Enumerator to request an application form. Send the completed application to:
NPI Enumerator
P.O. 6059
Fargo, ND 58108-6059
3. Apply by third party. With your permission, an organization may submit your application in an electronic file. This could mean that a professional association or perhaps a health care provider who is your employer could submit an electronic file containing your information and the information of other health care providers.
Contact Information
Contact Fox Systems directly with questions about processing an NPI application.
Telephone:
1-800-465-3203
1-800-692-2326 (TTY)
For more information, go to NPI in the Provider Library or contact Network Services at 505-837-8800 or 1-800-567-8540.
How do I participate in the Blue Medicare PPO network?
To participate in the Blue Medicare PPO provider network providers must:
- Be participating with BCBSNM
- Have a valid National Provider Identifier (NPI)
- Sign a Medicare Advantage Amendment to their BCBSNM Medical Services Entity Agreement
- Not have opted out of Medicare or have any sanctions or reprimands by any licensing authority of review organizations. Blue Medicare PPO participating providers cannot be named on the Office of the Inspector General (OIG) or Government Services Administration (GSA) lists that identify providers found guilty of fraudulent billing, misrepresentation of credentials, etc. Blue Medicare PPO participating providers cannot be sanctioned by the Office of Personnel Management or be prohibited from participation in the Federal Employees Health Benefit Program (FEHBP).
- Professional providers must have privileges at one of the Blue Medicare PPO participating hospitals (unless inpatient admissions are uncommon or not required for the physician's/professional provider's specialty)
For more information, go to Blue Medicare PPO.
Is the Blue Review newsletter distributed electronically?
We will be switching to an email-only distribution in early 2009. To receive an electronic copy, update your email information using the secure email form, Update Your Contact Information. Blue Review is also available online.
How can I avoid claim payment delays?
Always include the following information on your claims:
- Member's three-letter alpha prefix and the identification number (e.g. YIF1234567)
- Policy group number
- Onset date
- Physician's and/or supplier's name, address, telephone number
- Physician's and/or supplier's NPI
