How We Choose Providers for Our Networks

Blue Cross and Blue Shield of New Mexico (BCBSNM) is committed to having provider networks that meet access standards. To join our networks, providers and BCBSNM must agree to a contract. Our networks include medical and behavioral health providers. On a regular basis, we check to see if:

  • Provider locations meet member access needs
  • Members can get covered services from our network providers
  • We need to allow more providers into our networks

We make sure providers in our networks have proper credentials. We also require them to meet certain quality standards. Some of what we check for professional providers includes:

  • Education and training
  • Licensure
  • Record related to disciplinary, legal, licensing, substance abuse, and medical-legal history

Among other things,we also look at costs when contracting with providers. Our goal is for members to access quality health care that is cost efficient.

Medical Providers

BCBSNM works to contract with providers that offer services in all areas of medicine, including:

  • Family Practice
  • General Practice
  • Chiropractic Practice
  • Internal Medicine
  • Specialty
  • Subspecialty
  • General and specialty surgery
  • Rehabilitation

Behavioral Health Providers

In-network behavioral health providers provide the following services:

  • Psychiatry
  • Clinical Psychology
  • Licensed Clinical Social Work
  • Licensed Counseling, including Clinical Counseling and Marriage and Family Therapy

*This is not a complete list of in-network behavioral health provider specialties.

Your BCBSNM plan may use a tiered network. Based on cost, providers are placed into two tiers:

Tier 1: Members get the highest level of benefits and pay the lowest out-of-pocket costs
Tier 2: Members get a reduced level of benefits and pay higher out-of-pocket costs

How BCBSNM Chooses Hospitals

We check the locations of all hospitals in all of our networks to help ensure our members have access to in-network hospitals. BCBSNM wants to help ensure hospitals are available and accessible to members. We do not use quality, member experience or cost-related measures to choose hospitals for our networks.

Your BCBSNM plan may use a tiered network. Based on cost, hospitals are placed into two tiers:

Tier 1: Members get the highest level of benefits and pay the lowest out-of-pocket costs
Tier 2: Members get a reduced level of benefits and pay higher out-of-pocket costs