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Frequently Asked Questions (FAQs)

  • What is Centennial Care?

    Centennial Care is New Mexico's Medicaid managed care program. Medicaid members are enrolled with a managed care organization (MCO). Blue Cross and Blue Shield of New Mexico (BCBSNM) is one of the MCOs that offers Medicaid health plans. BCBSNM's plan is called Blue Cross Community CentennialSM.

    To learn more about Centennial Care, visit the New Mexico Human Services Department (HSD) website.

  • How does the Blue Cross Community Centennial Plan work?

    With this plan, you choose a primary care provider (PCP) from our statewide provider network. Your PCP will work with you to determine your health care needs. Your PCP will be the doctor who knows your health care needs the best.

    BCBSNM pays providers for Covered Services. This is at no charge to you. (A few services require WDI or CHIP members to pay a copayment. This is a fixed dollar amount that members must pay for a service. It must be paid at the time the member receives care.) You do not have to meet a deductible. You do not have to fill out claim forms when you see an in-network provider. See your benefit information for details.

  • What is a provider?

    A provider is a licensed doctor, facility, or health care professional. Your PCP is a provider. Providers offer medical products and services to health plan members.

  • What is an in-network provider?

    An in-network provider is a health care professional or a facility that is contracted with BCBSNM to provide services to Blue Cross Community Centennial members. Sometimes called a “participating provider.”

  • What is an out-of-network provider?

    An out-of-network provider is a health care professional or a facility that is not contracted with BCBSNM. Sometimes called a “non-participating provider.”

  • What is a Primary Care Provider (PCP)?

    Your PCP works with you for all your health care needs. Please call your PCP when you have a health need.

  • Why is it important to get to know my PCP?

    Your PCP knows you best. Your PCP knows your medical history. They also know your present state of health. Knowing this helps your PCP make the best decisions when you need medical care. Your PCP can also help arrange visits to specialists.

  • What if I’m sick and my PCP is not available?

    In-network PCPs have agreed to be accessible 24 hours a day for our members. Call your PCP to learn how to get care. If your PCP is not available, he or she will let you know how to access another doctor. Virtual visits are another way to get care. See the virtual visits FAQ below for more information.

  • How do I choose a PCP or change my PCP?

    If you are new to the plan and need to choose a PCP, fill out the PCP Selection Form and mail it to us. You can also call us and choose your PCP over the phone. If you would like to change your PCP, please call Blue Cross Community Centennial Member Services. Use the toll-free number on your member ID card, 1-866-689-1523 (TTY: 711).

  • What happens if my PCP or medical group leaves the network?

    If your PCP or medical group leaves the network, you will be told. To select a new PCP, please call Blue Cross Community Centennial Member Services. Use the toll-free number on your member ID card, 1-866-689-1523 (TTY: 711).

  • When do I need prior authorization?

    Some services require approval from BCBSNM. This approval is called “prior authorization.” If BCBSNM does not approve the services, the costs will not be covered (paid) by BCBSNM. You and your provider can still decide to get the services, but you may have to pay for them.

    Approval from BCBSNM is required before:

    • You are admitted as an inpatient to a hospital
    • You receive any of the services listed as needing approval
    • You visit a provider that is not in our provider network

    To request approval, you or your provider must call BCBSNM Health Services. Call 1-877-232-5518, Monday through Friday, 8 a.m. to 5 p.m. MT. In-network providers know which services need to be approved and they will ask BCBSNM for you. Out-of-network providers may not.

    If you are a Native American member, you do not need approval to visit Indian Health Service, Tribal, and Urban Indian providers (all together referred to as "I/T/U"). For services from a non-ITU provider, approvals are required for Native American members. Call 1-877-232-5518 (TTY: 711) to ask if those services need prior authorization.

    See a list of services requiring approval

  • Can I get a second opinion?

    Yes. You can get a second opinion for any procedure or treatment. Your doctor can recommend a specialist. You or your doctor can call BCBSNM for assistance. You must get your second opinion from providers who are in the Blue Cross Community Centennial network or get a prior authorization from BCBSNM to see a provider outside the network.

  • Do I need a referral to see a specialist?

    No. But please make sure the specialist is in the Blue Cross Community Centennial network. Also see if the services are covered by your plan before you make an appointment. Otherwise, you will have to pay the costs of services not covered. Even if you don’t need a referral for some services with specialists, you may need prior approval. Ask your PCP. Your PCP knows your medical history. Your PCP is best qualified to help arrange your medical care. This includes visits to specialists.

  • What is a medical emergency?

    An emergency is a sudden medical condition with severe symptoms. These symptoms can include intense pain. Without immediate medical help, your health and life could be in danger. Emergency conditions can damage bodily functions. They can cause serious injury to body organs or parts. Examples of emergencies are:

    • Heart attack
    • Stroke
    • Bad chest pain or other pain that does not go away
    • Hard time breathing
    • Bleeding that does not stop
    • Loss of consciousness (passing out)
    • Seizures
    • Poisoning or drug overdose
    • Severe burns
    • Serious injury from an accident or fall
    • Broken bones
    • Injured eye or sudden loss of eye sight
    • Feelings of wanting to hurt yourself or others

    Services received in an emergency room (ER) or other trauma center must meet the definition of "emergency" to be covered. Services received in a doctor's office or urgent care facility are not considered emergencies.

    See the Member Handbook for guidelines on emergency care coverage.

  • What do I do in an emergency?

    BCBSNM wants to help make sure you get proper care in an emergency. Here's what you need to do:

    • In an emergency, if you can do so safely, go to the nearest hospital or trauma center.
    • You can call "911" or other community emergency resources for help in an emergency.
    • You do not need approval for emergency services.
    • Please call BCBSNM within 48 hours of the admission. Our toll-free number is on the back of your member ID card, 1-866-689-1523 (TTY: 711).
    • Call your PCP as soon as possible after receiving emergency care or being admitted as an inpatient. Do this so your PCP can arrange for follow-up care.

    Note: Members who use an emergency room when it is not necessary may be responsible for paying an emergency room copayment.

  • How can I get emergency care when traveling?

    If you are traveling and need emergency care, call “911.” Or if you can do so safely, go to the nearest emergency room or trauma center. When you return home, call your PCP or Care Coordinator to arrange follow-up care.

  • What is urgent care?

    Urgent care is medical treatment for a condition that is not life-threatening. The condition requires prompt medical attention to prevent serious health problems. If you need advice, you can call our toll-free 24/7 Nurseline at 1-877-213-2567 (TTY: 711). See the Member Handbook for guidelines on what urgent care is covered.

  • How do I get urgent care?

    Sometimes you don’t have an emergency condition but feel you need medical attention quickly. If so, go to an urgent care clinic in our network. You can also call our toll-free 24/7 Nurseline at 1-877-213-2567 (TTY: 711).
    Note:
    Your wait time at urgent care may be shorter than if you go to an emergency room. It’s important to save the ER for emergencies.

  • What are virtual visits?

    Virtual visits are another way to get care. Blue Cross Community Centennial members can access care for non-emergency health issues and behavioral health needs through MDLIVE®. With MDLIVE's virtual visits, you can speak to a doctor or therapist quickly or make an appointment based on your availability. The average wait time is less than 10 minutes. Visit the website MDLIVE.com/bcbsnm-centennial to video chat with a doctor, psychiatrist, or therapist. Virtual visits may be a better choice than going to the emergency room or urgent care center.

  • What should I do if I lose my ID card?

    Call Blue Cross Community Centennial Member Services at 1-866-689-1523 (TTY: 711) to ask for a new ID card. It will take up to two weeks to receive a new card. If you need a temporary ID card while you wait for your new card, you can print a letter to give to your provider. Just log in to Blue Access for MembersSM. Go to My Coverage. Click on Print Temporary ID Card.

  • How does the prescription drug plan work?

    Please see Drug Coverage for information.

  • What if I have questions about my benefits?

    Call Blue Cross Community Centennial Member Services toll-free at 1-866-689-1523 from 8 a.m. to 5 p.m. MT, Monday through Friday. Member Services is closed Saturdays and Sundays and the following holidays: New Year's Day, Memorial Day, Independence Day, Labor Day, Thanksgiving Day and Christmas. If you call after hours, leave a message. We will return your call the next business day. Please have your ID card when you call. Members with hearing or speech loss can call the TTY/TDD line at 711. You may also email your questions to Member Services.