Appeals Process 
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
BlueCard® Claim Filing
The BlueCard Program links participating health care providers and the independent Blue Cross and Blue Shield Plans across the country and around the world through a single electronic network for claims processing and reimbursement.
The program allows you to submit claims for patients from other domestic and international Blue Cross Blue Shield Plans directly to your local Blue Plan. Your local Blue Plan will be your contact for claims payment, problem resolution, adjustments, and inquiries.
BlueCard Training Webinars
- September 28, 2010, 9:00-10:00 a.m. MT
- October 19, 2010, 2:00-3:00 p.m. MT
- November 9, 2010, 9:00-10:00 a.m. MT
- December 2, 2010, 2:00-3:00 p.m. MT
- December 23, 2010, 2:00-3:00 p.m. MT
CMS-1500 User Guide
In a continuing effort to reduce administrative costs and improve claim turnaround, Blue Cross and Blue Shield of New Mexico require complete CMS-1500 information on all claims, including National Provider Identifier (NPI). Incomplete claim forms will be returned to you for required information. See the CMS-1500 Tutorial for additional information.
Coverage and Billing Information for Novel H1N1 Vaccine
With the impending delivery of the new vaccine for the novel influenza A (H1N1) flu virus, we want to make our network physicians aware of our policy concerning coverage of charges for administering the vaccine for BCBSNM members.
Taxonomy Codes – Definition and Claims Use
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.
Timely Claim Filing
Section 8.9 describes both hard-copy and electronic claims submission processes. For those provider offices that are not submitting claims electronically, we encourage you to consider this faster, easier, and more accurate method for claims submission. We would be happy to help you make this transition. See Electronic Commerce for more information on filing claims electronically.
Tips for Preventing Claim Delays
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.
UB04 User Guide
The Uniform Bill (UB-04) is the standardized billing form for institutional services. This is a guide to help with completion of the UB-04 form for your patients with Blue Cross (facility) coverage.
Some of the information above is available as PDF files. If you do not have Adobe® Reader®, download it free of charge at Adobe's site.
