December 6, 2021
Updated January 20, 2022
Beginning Jan. 1, 2022, fully-insured commercial, student health, retail, and Interagency Benefits Advisory Committee (IBAC)* Blue Cross and Blue Shield of New Mexico (BCBSNM) members** have no cost-sharing for certain behavioral health (BH) services as defined in New Mexico Senate Bill 317 (2021). Providers should not collect cost-sharing from these members for such services. Providers will be reimbursed at the full contracted rate for impacted claims.
*IBAC inclusive of the following groups: Albuquerque Public Schools (APS), New Mexico Public Schools Insurance Authority (NMPSIA), New Mexico Retiree Health Care Authority (NMRHCA), and State of New Mexico Risk Management Division (SONM).
**Cost-sharing is not waived for any other BCBSNM members, including but not limited to self-insured commercial members, Federal Employee Program members and members of other Blue Cross and Blue Shield plans. Please see the January 14, 2022 Notice from the New Mexico Office of the Superintendent of Insurance (OSI) for additional information.
Remember to check patient eligibility and benefits prior to rendering services.
Benefit exclusions, network requirements and utilization management policies, including prior authorization, remain applicable. Members with HSA-eligible High Deductible Health Plans must meet the deductible first before services and medications can be covered without cost-sharing.
The cost share waiver applies to the following BH services, as further informed by OSI Bulletin 2021-009 :
professional and ancillary services for the treatment, habilitation, prevention and identification of mental illnesses, substance abuse disorders and trauma spectrum disorders, including inpatient, detoxification, residential treatment and partial hospitalization, intensive outpatient therapy, outpatient and all medications, including brand-name pharmacy drugs when generics are unavailable.
Check Patient Eligibility and Benefits
Patient eligibility and benefits should be verified prior to every scheduled appointment. Eligibility and benefit quotes include membership verification, coverage status and other important information, such as applicable copayment, coinsurance and deductible amounts.
Providers are strongly encouraged to use availity.com or their preferred vendor for eligibility and benefit verifications.
Please note that if BCBSNM must reimburse a member for cost sharing paid for a BH service or medication, BCBSNM may recoup the reimbursement amount from the network provider that accepted the cost sharing from the member.
Verification of eligibility and/or benefit information is not a guarantee of payment. Benefits will be determined once a claim is received and will be based upon, among other things, the member's eligibility, any claims received during the interim period and the terms of the member's certificate of coverage applicable on the date services were rendered.