Provider Information on COVID-19 Coverage
Blue Cross and Blue Shield of New Mexico (BCBSNM) is covering testing to diagnose the 2019 Novel Coronavirus (COVID-19) for most members with no prior authorization needed and no member copays or deductibles. For treatment of COVID-19, we cover medically necessary health benefits, including physician services, hospitalization and emergency services consistent with the terms of each member's benefit plan. Members should always call the number on their ID card for answers to their specific benefit questions.
Note: Many of our members are covered under a health plan that is self-insured by their employer. Some of these members may be responsible for copay or deductibles, based on their employer's election to participate in this benefit.
Check Members Eligibility and Benefits
Use the Availity® Provider Portal or your preferred vendor for eligibility and benefit verifications.
Claims for COVID-19 Testing
If you test a member when it's medically necessary and consistent with CDC guidance, submit the claim to us using HCPCS code U0002. The Centers for Medicare and Medicaid Services (CMS) has set the price for the COVID-19 diagnostic tests. We will follow CMS pricing and apply the terms of our contracts.
Out-of -Network Providers
If you are not in our networks, our allowed amount for U0002 is consistent with Medicare pricing.
Many members have telehealth benefits. For those members, telehealth visits will be covered as a regular office visit for providers who offer the service through 2-way, live interactive telephone or digital video consultations. Some plans also provide access to MDLive, a vendor with a network of physicians who provide telehealth services. Learn more .
For members who have BCBSNM pharmacy benefits administered through Prime Therapeutics, BCBSNM will allow members to receive an early fill of their medication for the same quantity as the last prescription filled. We also encourage members to use their 90-day mail order benefit, if applicable. All pharmacy practice safety measures, as well as prescribing and dispensing laws, will remain.
We are also prepared for medication shortages or access issues. Patients will not be liable for additional charges that may stem from obtaining a non-preferred medication if the preferred medication is not available due to shortage or access issues.
What is the risk of COVID-19?
According to recent reports from the CDC, the immediate health risk from COVID-19 is low. We are ready to help you serve our members and the community in understanding, preventing and potentially treating people who have been affected by the COVID-19.
We've developed a member-facing flier about COVID-19 that you may share with your patients.
Because this is a rapidly evolving situation, you should continue to use Centers for Disease Control guidance on COVID-19, as the CDC has the most up-to-date information and recommendations. In addition, watch for updates on BCBSNM News and Updates.
If you have any questions or if you need additional information, please contact your BCBSNM Provider Relations Representative.