Providers with issues related to specific BlueCard claims may contact our BlueCard Executive to request assistance. The BlueCard Executive is a designated senior-level individual at Blue Cross and Blue Shield of New Mexico accountable for resolving escalated issues regarding certain BlueCard claim payments.
Who this applies to: Only providers who are members of the Provider Multidistrict Litigation Settlement Class can engage the BlueCard Executive.
Which claims can be escalated: BlueCard Executives can receive escalations for claims that meet the following criteria:
- Open BlueCard claims aged 45 calendar days or more from the submission date and billed charges of $1 million or more
- Open BlueCard claims aged 60 calendar days or more from the submission date and billed charges of $500,000 or more
- Open BlueCard claims aged 90 calendar days or more from the submission date and billed charges of $300,000 or more
All other BlueCard issues must be addressed using existing dispute and/or appeals processes first. Escalations that do not meet the above criteria will be returned to the requestor advising that the request should be submitted through our other dispute and appeals processes.
How to contact the BlueCard Executive if you have an eligible escalation: Providers serviced by BCBSNM can request eligible escalations by emailing the BlueCard Executive. Your email should include claim number, member ID, date of service, patient name and any other pertinent details.
If the claim in question requires information or assistance from another Blue Plan, your BlueCard Executive will coordinate with the other Plan to resolve the inquiry.
For more information, refer to the provider settlement website.