Network Participation



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Blue Cross and Blue Shield of New Mexico (BCBSNM) appreciates your interest in becoming a contracting provider with our health care organization. We contract with physicians, facilities and other health care professionals to ensure that our members receive accessible, cost effective and quality health care services.




Prior to claim submission, rendering providers must request and obtain a BCBSNM provider record. The provider record associates the provider's rendering National Provider Identifier (NPI) with their billing NPI and tax identification number (TIN).


Office hours
Due to the new provider directory requirements, office hours must reflect each practice location, facility and individual provider. All provider applications request office hours be submitted. If the office hours are not submitted on the application, Provider Finder® will list office hours as 8 a.m. to 5 p.m. If this is an inaccurate representation of your hours please visit the Update Your Provider Information page or contact us at 800-567-8540.


Facilities and Ancillary providers
Complete the application for facility/agency/vendor participation form Adobe Acrobat PDF.
Behavioral Health providers complete the application for behavioral health facility/agency/vendor form Adobe Acrobat PDF.


Urgent Care Centers
Complete the group provider record/contracting packet Adobe Acrobat PDF and the urgent care center attestation Adobe Acrobat PDF.


Physicians and other professional providers
Requesting a provider record from BCBSNM does not mean you are a participating network provider.

  • If you do not already have a provider record established with BCBSNM, you will need to complete one of the provider record information packets below (solo or group).
  • If you need to check on the status of a previously submitted provider record or have questions regarding the completion of the packet, contact the Network Services department at 505-837-8800 or 800-567-8540/strong>.
  • If you checked the box on the form to participate in the BCBSNM networks, you will receive a medical services entity agreement (MSEA) or a behavioral health services entity agreement (BHSEA).

Solo provider record/contracting packet Adobe Acrobat PDF or behavioral health solo provider record/contracting packet Adobe Acrobat PDF should be completed by a provider:

  • who will not be employing another professional provider
  • who will be using his/her social security number for tax purposes
  • whose TIN is legally filed under the provider's name
  • who is not incorporated

 

Group provider record/contracting packet Adobe Acrobat PDF or behavioral health group provider record/contracting packet Adobe Acrobat PDF should be completed by:

  • a provider who has a practice with more than one professional provider
  • a provider whose federal TIN has a corporate legal name
  • a provider whose billing entity is incorporated
  • an existing group adding a new provider — complete the entire packet for each provider joining the group

Atypical providers
Atypical providers are those who care for members requiring long-term care services in Home and Community-Based Settings (HCBS) and are requesting to participate in the Blue Cross Community CentennialSM Medicaid program. Atypical providers are not required to complete the CAQH credentialing process; however, they will go through the network services provider validation process. Complete the Application for NM Medicaid Atypical Providers Adobe Acrobat PDF.

Home and Community-Based Setting providers include:

  • Adult Day Health
  • Assisted Living Facilities
  • Community Transition Services
  • Emergency Response Service Coordination
  • Environmental Modifications
  • Behavioral Support Consultation
  • Employment Supports
  • Home Health Aid Services
  • Personal Care Services
  • Private Duty Nursing for Adults
  • Respite Services
  • Skilled Maintenance Therapy Services
  • Support Brokers
  • Community Intervener

BCBSNM requires providers to use the Council for Affordable Quality Healthcare® (CAQH) for initial credentialing and recredentialing. Universal Provider DatasourceTM (UPD) a free online service, allows providers to fill out one application to meet the credentialing data needs of multiple organizations. This solution helps to ensure the accuracy and integrity of our provider database.


Note: BCBSNM's requirement of use of the UPD does not apply to providers participating through delegated credentialing agreements/contracts or are solely practicing in a hospital based environment.


Activating Your UPD Registration with CAQH*

Once your provider record has been set up and you have requested to participate in the BCBSNM provider networks, you will need to be credentialed. Participating providers must have a CAQH provider identification (ID) to register and begin the credentialing process.


First Time Users

  • If you are not registered with CAQH — When you obtain a BCBSNM provider record for claim payment and submit a current signed BCBSNM contract/agreement, BCBSNM will add your name to its roster with CAQH. CAQH will then mail to you the access and registration instructions, along with your personal CAQH provider ID, allowing you to obtain immediate access to UPD via the internet.
  • When you receive your CAQH provider ID, go to the CAQH website  to register.
    Note: Registration and completion of the online application is free. Once registration is completed, you may use your UPD user name and password to log in at any time.

 

Existing Users


If you are already registered with CAQH and completed your UPD application through your participation with another health plan, log in to the UPD and add BCBSNM as one of the health plans that can access your information. Refer to Authorize Tab instructions in the CAQH Reference Guide 


Completing the Application Process


When you are ready to begin entering your data, log in to the UPD  with your user name and password.


If you have any questions about accessing the UPD , contact the CAQH Support Desk for assistance.


CAQH Contact Information 

  • Help Desk: 888-599-1771
  • Help Desk email address: caqh.uphelp@acsgs.com
  • Help Desk hours: 5 a.m. – 7 p.m., MT, Monday – Thursday and 5 a.m. – 5 p.m., MT, Friday

View the 5-minute tutorial  for completing the UPD application.

View the application process .

See the Blues Provider Reference Manual, Section 16 – Credentialing 


Note: BCBSNM may need to supplement, clarify or confirm certain responses on your application with you. Therefore, you may be required to provide us with supplemental documentation in some situations, in addition to the information you submit through the UPD.


BCBSNM requires full credentialing of the physicians and other professional providers listed below for participation in the networks.


  • MDs and DOs
  • DDSs (oral and maxillofacial surgery)
  • licensed physical therapists and occupational therapists
  • optometrists, audiologists, speech and language pathologists
  • behavioral health providers*
  • physician assistants, surgical assistants, advanced practice nurses, certified midwives, registered nurse first assistants
  • podiatrists
  • chiropractors
  • acupuncturists

 

* The licensing board for psychologists (PhDs) does not provide a quick verification method of a provider's license. PhDs will be fully credentialed and made effective after credentialing approval.


Note: If you are a provider that requires one of the following additional forms listed below, you must complete and forward by fax to 866-290-7718 or 505-816-2688.

 

 


Follow the table below to submit a request for contracting/participating in the New Mexico networks.

  • Eligible specialties include, but are not limited to, anesthesia, emergency medicine, radiology, pathology, neonatology and hospitalist.
  • The facility based application only applies to providers who practice exclusively in a facility, either a hospital or a freestanding outpatient facility.

 

Hospital or facility based providers must have the following:

  • hospital privileges
  • type 1 NPI #
  • NM State Board of Medical Examiners license (temporary permit is acceptable) or appropriate NM licensure
  • certificate/AANA# (applicable to certified registered nurse anesthetist providers only)

Note: A BCBSNM provider record does not automatically activate the NM network. Claims will be processed out-of-network, until the provider has applied for network participation, been approved and activated in the network.

If provider is ….

THEN ….

with a medical group that is currently contracted with NM networks.

a solo practitioner or medical group interested in contracting as a facility based provider with NM network.

  • Refer to How to Join the BCBSNM Provider Networks section above for each provider billing under TIN. (If applicable record does not already exist)
  • Complete the facility based provider application Adobe Acrobat PDF and fax to 866-290-7718 or 505-816-2688.


Keeping your information current with CAQH and BCBSNM is your responsibility.


BCBSNM members rely on the accuracy of the provider information in our online Provider Finder® . This is why it's very important that you inform BCBSNM whenever any of your practice information changes. If you are a participating provider with BCBSNM, you may request most changes online by emailing us.


CAQH UPD:
You will be sent automatic reminders from CAQH to review and attest to the accuracy of your data. Use the UPD  to report any changes to your practice.


The process of recredentialing is identical to that for credentialing, and is consistent with National Committee for Quality Assurance and State of New Mexico requirements.


If you are not currently registered with CAQH, BCBSNM will add your name to its roster with CAQH. CAQH will then mail to you the access and registration instructions, along with your personal CAQH provider ID, allowing you to obtain immediate access to the UPD via the internet to complete and submit your application. This will help you to conform to the requirements of your provider contract/agreement to continue your participation with BCBSNM's networks.


If you are an existing user of CAQH, you are required to review and attest to your data once every 4 months. At the time you are scheduled for recredentialing, BCBSNM will send your name to CAQH to determine if you have already completed the UPD credentialing process and authorized BCBSNM or selected "global authorization". If so, BCBSNM will be able to obtain current information from the UPD database and complete the recredentialing process without having to contact you.


If you are contracted for the Medicaid network, a provider disclosure  must be completed and submitted with your current documents to CAQH as part of the complete application packet.


Note: If you are a provider that requires one of the following additional forms listed below, you must complete and forward by fax or mail to BCBSNM as indicated below.

 

Forward applicable completed form(s) to BCBSNM:

Fax to: 866-290-7718 or 505-816-2688 (preferred method)

or

Mail to:
Blue Cross and Blue Shield of New Mexico
Network Services Department
P.O. Box 27630
Albuquerque, NM 87125-7630

*The Council for Affordable Quality Healthcare, Inc. (CAQH) is a not-for-profit collaborative alliance of the nation's leading health plans and networks. The mission of CAQH is to improve health care access and quality for patients and reduce administrative requirements for physicians and other health care providers and their office staffs.

CAQH is solely responsible for its products and services, including the Universal Provider Datasource.