In October we highlighted changes starting Jan. 1, 2022, for the Consolidated Appropriations Act (CAA) of 2021 and the Transparency in Coverage Final Rule. To further support you, the Availity Provider Portal helps providers and Blue Cross and Blue Shield of New Mexico (BCBSNM) quickly and securely share information, including information defined by the CAA.
You can access the self-service tools below through the Availity portal. Refer to the below Resources for each tool to learn more, including instructional user guides and important tips.
Not yet registered with Availity?
Sign up now at no cost on Availity.
- For help registering, contact Availity Client Services at 800-282-4548.
- If you need customized training or help with these tools, contact our Provider Education Consultants.
Administrative Tools |
Descriptions |
More Resources |
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Provider Data Management |
Verify and update your provider directory information with BCBSNM every 90 days. |
Provider Directory Information Verification |
Fee Schedule Listing |
Electronically request up to 20 procedure codes and immediately receive the contracted price allowance for services. |
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Pre-Service Tools |
Descriptions |
More Resources |
Eligibility and Benefits Inquiry |
Verify real-time patient eligibility, check coverage details, determine prior authorization requirements and view and/or print an image of the member’s ID card. |
New Information on Member ID Cards |
Patient ID Finder |
Obtain the BCBSNM patient ID and group number. |
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Patient Care Summary |
Obtain a consolidated view of a patient’s health care history within the last 24 months. |
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Patient Cost Estimator* |
Estimate a patient’s potential out-of-pocket costs. |
Patient Cost Estimator User Guide |
Attachments: Predetermination Requests* |
Submit predetermination of benefits requests handled by BCBSNM. |
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Authorizations |
Submit prior authorization requests handled by BCBSNM. |
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Post-Service Tools |
Descriptions |
More Resources |
Claim Status |
Check enhanced, real-time claim status. |
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Independent Dispute Resolution (IDR) |
Initiate a claim dispute for non-contracted providers. |
Surpise Billing Provisions of No Surprises Act |
Clinical Claim Appeal Requests** |
Submit appeal requests for specific clinical claim denials using the Availity Claim Status tool, when applicable. |
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Research Procedure Code Edits (Clear Claim ConnectionTM)* |
Determine how coding combinations on a specific claim may be evaluated during the adjudication process. |
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National Drug Code (NDC) Units Calculator |
Convert applicable classified or specified Healthcare Common Procedure Coding System (HCPCS) or Current Procedural Terminology (CPT®) codes to NDC units. |
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Reporting On-Demand |
View, download, save and/or print the Provider Claim Summary (PCS) for finalized claims. |
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Remittance Viewer |
View and reconcile claim data in the 835 Electronic Remittance Advice (ERA). |
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Electronic Refund Management (eRM)* |
Reconcile claim overpayments and manage refund requests. |
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Claim Inquiry Resolution (CIR)* |
Submit claim reconsideration request for certain finalized claims. |
*Unavailable for Medicare Advantage members.
**Clinical Claim Appeal Requests are ONLY available for Federal Employee Program (FEP) and Blue Cross Community CentennialSM claims.
Checking 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 and the terms of the member’s certificate of coverage applicable on the date services were rendered. If you have any questions, please call the number on the member’s ID card.
ClaimsXten and Clear Claim Connection are trademarks of Change Healthcare, an independent company providing coding software to BCBSNM. Change Healthcare is solely responsible for the software and all the contents. Contact the vendor directly with any questions about the products, software and services they provide.
RC Claim AssistTM Copyright 2021 RJ Health. RC Claim AssistTM is a product of RJ Health. RJ Health is an independent third-party vendor that is solely responsible for its products and service.
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. If you have any questions about the products or services provided by such vendors, you should contact the vendor(s) directly.
CPT copyright 2021 American Medical Association (AMA). All rights reserved. CPT is a registered trademark of the AMA.