Standards and Requirements
The means by which Blue Cross and Blue Shield of New Mexico exchanges member data with providers will change dramatically over the next several years. Upgrading ANSI 4010 to ANSI 5010 is required by a directive from the U.S. Department of Health and Human Services. That directive makes the same requirement of providers. Learn More.
Medical Policies are based on scientific and medical research. They are often used as guidelines for coverage determinations in health care benefit programs. Explore Medical Policy drafts that are currently being considered.
On Jan. 16, 2009, the U.S. Department of Health and Human Services released a final rule mandating that everyone covered by the Health Insurance Portability and Accountability Act must transition from ICD-9 code sets and adopt ICD-10-CM diagnosis codes and ICD-10-PCS procedure codes. Learn More.
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.
Provider Reference Manual Table of Contents with Changes and Updates Preface
View the Provider Reference Manual
Learn more about the the RBRVS relative values units to calculate your reimbursement.