December 6, 2021
Updated January 20, 2022
Updated February 15, 2022
Beginning Jan. 1, 2022, fully-insured commercial, 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.
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.
How to Tell if a Member May be Eligible for the Cost-Share Waiver by Member ID Card
BCBSNM Member ID cards appear differently for members with various health insurance plans. Below are several examples of Member ID cards and descriptions of their differences.
Fully-Insured Retail and Commercial Members (these members are included in the cost-share waiver)
- Fully-insured retail members purchase their own health insurance plan directly. Fully-insured commercial members purchase health insurance through their employer.
- Fully-insured retail and commercial members will have an informational disclosure on the back of their Member ID card that is identical or similar to the disclosure outlined in red below. Please note that the informational disclosure will not reference claims processing or the financial risk for claims.
IBAC BCBSNM Members (these members are included in the cost-share waiver)
IBAC BCBSNM members will have a logo on the front of the Member ID Card referring to the IBAC organization for which they are a member. Examples of these logos are:
Additionally, these Member ID cards will have the following informational disclosure on the back:
“BlueCross BlueShield of New Mexico, an Independent Licensee of the Blue Cross and Blue Shield Association, provides claims processing only and assumes no financial risk for claims.”
FEP Members (these members are not included in the cost-share waiver)
- FEP members will have the words “Federal Employee Program.” under the BlueCross BlueShield logo on the front of the Member ID card.
ASO or Self-Insured Members (these members are not included in the cost-share waiver)
- Members whose financial responsibility for claims is paid for by their employer.
- ASO/Self-Insured Members will have the following informational disclosure on the back of their Member ID card, but without any accompanying IBAC group logo on the Member ID card: “BlueCross BlueShield of New Mexico, an Independent Licensee of the Blue Cross and Blue Shield Association, provides claims processing only and assumes no financial risk for claims.”
Remember: Member ID cards are for identification purposes only. The examples above are for informational purposes only, and the presence or absence of certain information on a member’s ID card is not a guarantee of the member’s eligibility for the BH cost share waiver. Providers are strongly encouraged to check patient eligibility and benefits prior to rendering services.
For more information about this communication, please see OSI Bulletin 2021-009 or contact Provider Customer Service at 888-349-3706.
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.