Retainer Payments for Personal Care Services Providers - Special COVID LOD #12; Community Benefit, Appendix K

July 22, 2020

Personal Care Service (PCS) providers may begin to submit claims directly to Blue Cross and Blue Shield of New Mexico (BCBSNM) for retainer payments as outlined in Special COVID LOD #12 Learn more about third-party links. Providers should use the Availity™ portal. Providers may also submit paper claims directly to BCBSNM; however, this is not recommended and will increase the time required to process payment. Please do not use AuthentiCare for submission of retainer payments to BCBSNM; this will result in the denial of claims.

To receive payment, PCS providers must use the correct PCS procedure code (T1019 or 99509) and modifier 52. Please note that BCBSNM will utilize the criteria outlined in Special COVID LOD #12 Learn more about third-party links for payment.

  • Retainer payments are limited to approved personal care services and may not exceed twelve (12) days.
  • BCBSNM shall reimburse providers 100% of their current rate inclusive of GRT for retainer payment.
  • PCS providers should not bill retainer payments for one service if providing a similar service to the same member in the same time period.
  • Retainer payments will not be authorized when a provider is providing services and will only occur on a case-by-case basis when a member is directly impacted by the emergency, i.e., sequestered and/or quarantined.
  • Retainer payments may not be billed when the member chooses to receive services through a different provider. Retainer payments will not be made if the member receives the same service from a different provider within the same time period.
  • PCS providers should continue to utilize AuthentiCare for all services that are provided and not eligible to be billed as retainer payments. As described in the LOD, providers must pass retainer payment funds to caregivers to maintain staffing levels during the Public Health Emergency.

If you have any questions regarding this letter, please contact your BCBSNM Provider Representative.
Thank you for your support and care of our members in these challenging times.