Third-Party Liability Claims Processing for Blue Cross Community Centennial(SM)

The New Mexico Human Services Department (HSD), Medicaid Assistance Division (MAD) and Blue Cross and Blue Shield of New Mexico (BCBSNM) are now following standard procedure for prenatal services claims when a member has more than one insurance plan. This includes claims for labor and delivery and post-partum care.

What’s changed: When a member has more than one insurance plan, BCBSNM Blue Cross Community Centennial is the secondary payer. That means we pay after the members’ primary plan pays. Before Jan. 1, 2022, we would pay claims for prenatal services before the primary plan paid. Now, we deny those claims if they are not submitted with the explanation of benefits (EOB) from the primary insurer.

Action item: File prenatal services claims for Blue Cross Community Centennial members with the member’s primary insurer before filing Medicaid claims with BCBSNM. Then submit your claim to BCBSNM with the primary insurance EOB or primary insurance payment information.

Complying with Regulation: This change fulfills the third-party liability requirements of the 2018 Bipartisan Budget Act of 2018 and the Medicaid Services Investment and Accountability Act of 2019.

More information: Read more with HSD Supplement 22-01.

For more information, please contact the Medical Assistance Division at