Clarification: New BCBSNM 837 Commercial Claim Validation Edits Effective April 1, 2020

March 17, 2020

This is a follow-up to provide clarification on a previous notice, posted March 3, 2020.

Starting April 1, 2020, Blue Cross and Blue Shield of New Mexico (BCBSNM) will begin implementing enhancements to our electronic claim submission validation edits for commercial Professional and Institutional claims (837P and 837I transactions). * These enhancements will allow claim edits to be applied to claims during the pre-adjudication process, giving you the ability to identify errors earlier in the process and make necessary corrections more quickly.

  • Currently, electronic claim submissions are accepted into the BCBSNM adjudication system for processing and then deny when needed data elements are not included.
  • If you submit claims electronically on or after April 1, 2020, you may see new edit messages on the response files from your practice management system or clearinghouse vendor(s) before the claim is adjudicated. These responses will specify if additional data elements are required.
  • If you receive claim rejections, the affected claims must be corrected and resubmitted with the needed information as specified in the rejection message.

If you have questions regarding an electronic claim rejection message, contact your practice management/hospital information system software vendor, billing service or clearinghouse for assistance.

*These new validation edits do not apply to Medicare Advantage electronic claim submissions.