New Laboratory Policies Coming Jan. 1, 2022

October 20, 2021

Beginning Jan. 1, 2022, Blue Cross and Blue Shield of New Mexico (BCBSNM) will implement new policies and a new program for claims for certain outpatient laboratory services provided to our Fully Insured commercial members. Our New Laboratory Management Program will help ensure our members get the right care at the right time and in the right setting. It will also help you better prepare and submit claims that support and reflect high quality, affordable care delivery to our members.

See below for key points to help you prepare.

Medical Policy Updates:
Watch for new and revised BCBSNM Medical Policies and reimbursement policies effective Jan. 1, 2022, related to certain laboratory, services, tests, and procedures. Also refer to our Clinical Payment and Coding Policies.

Affected claims: our new program will include the following outpatient laboratory claims:

  • Dates-of-service on or after Jan. 1, 2022
  • Performed in an outpatient setting (typically office, hospital outpatient, or independent laboratory)

Note: Laboratory services provided in emergency room, hospital observation and hospital inpatient settings are excluded from this program. Member contract benefits and clinical criteria still apply.

New Claim Simulation Tool:
Effective Jan. 1, 2022, you can get free access to the program’s Trial Claim Advice Tool, which allows you to input codes and diagnoses to see, before submitting a claim, the potential outcome of your claim. The Trial Claim Advice Tool is a free simulation tool and does not guarantee approval, coverage, or reimbursement of services. Responses consider information entered through the tool for the date of service entered and historical claims finalized through the previous business day. Claims not yet finalized won’t be considered.

What you need to do:

  • To access the Trial Claim Advice Tool, log on to the Availity® Provider Portal Learn more about third-party links.
  • To get to the Trial Claim Advice Tool, use the single sign-on feature via the BCBSNM-branded Payer Spaces section within the Availity portal.
  • If you’re not a registered Availity user, we encourage you to sign up before the January 2022 program activation, to gain access to the Trial Claim Advice Tool. Register on the Availity website Learn more about third-party links today, at no charge. For registration help, call Availity Client Services at 800-282-4548.

Provider Training:
Attend free webinars on how to use the Trial Claim Advice Tool and learn more about the Laboratory Management Program. To register, select your preferred date and time from the list below:

For More Information:
Continue to watch News and Updates for more information.

Availity is a trademark of Availity, LLC, a separate company that operates a health information network to provide electronic information exchange services to medical professionals. Availity provides administrative services to BCBSNM. BCBSNM makes no endorsement, representations or warranties regarding any products or services provided by third party vendors such as Availity.