Federal Employee Program® (FEP®)
For further information regarding specific Federal Employee Program (FEP) Medical Policies or Federal Employee Program (FEP) Service Benefit Plan Brochure, please visit the FEP website to learn more.
Medical Policies
Medical Policies are based on research that provides evidence of scientific merit for a particular medical technology. In most cases, they are used as guidelines for coverage determinations in health care benefit programs. Explore more about Medical Policies.
Medical Policy and Prior Authorization for Out-of-Area Members
Medical Policy and Prior Authorization for Out-of-Area Members
Medical Records Documentation Standards
Medical Records Documentation Standards
Provider Reference Manual
The Provider Reference Manual is designed for ease of use while providing a comprehensive resource tool for your office View the Provider Reference Manual
Reimbursement Calculations
Learn more about the the RBRVS relative values units to calculate your reimbursement.
Reimbursement Policies
Reimbursement policies (formerly known as clinical payment and coding policies) are based on criteria developed by specialized professional societies, MCG Health national guidelines and the CMS Provider Reimbursement Manual.
Documentation Guidelines for Urine Drug Testing
BCBSNM processes and reimburses claims for urine drug testing in accordance with BCBSNM Medical Policy MED207.154, “Drug Testing in Pain Management and Substance Use Disorder Monitoring.” BCBSNM only reimburses claims for urine drug testing that are medically necessary under that medical policy. BCBSNM requires that urine drug testing claims be properly documented and that the documentation reflect the medical necessity of the testing. Learn More.
Providing Reimbursable Telemedicine Services
BCBSNM encourages its contracted providers to furnish covered services to Medicaid members via qualifying and compliant interactive telecommunications systems and/or asynchronous store-and-forward technology, where clinically appropriate, especially to those members living in rural or frontier areas of the state (Telemedicine). The State of New Mexico Health Care Authority allows reimbursement for Telemedicine where program requirements are met. Learn More.