September 28, 2020
Beginning Jan. 1, 2021, we will require facilities to submit an itemized bill for inpatient care billed for $100,000 or more. This applies to all facility claims for $100,000 or more submitted for BlueCard out-of-area Blue Cross and Blue Shield members. An itemized bill helps ensure an accurate claim payment and reduces the need to submit more information after a claim is paid.
The BlueCard claim amount requiring itemization will be lowered to $100,000 from the current $200,000 threshold.
How to Submit Itemized Bills
You may submit itemized bills electronically using our Claim Inquiry Resolution tool. Include the corresponding claim number for quicker review and turnaround time.
Refer to our Inpatient/Outpatient Unbundling Policy (Clinical Payment and Coding Policy 002) on our provider website for more information. If you have any questions, please contact your Blue Cross and Blue Shield of New Mexico (BCBSNM) Provider Network Representative.