Tools

At Blue Cross and Blue Shield of New Mexico (BCBSNM), we are committed to providing support to physician practices. We’ve designed tools that health care providers find useful. Whether doing research or streamlining billing, these tools can help you evaluate costs, save time, improve service and more.

Altruista Health’s GuidingCareTM Portal via Availity® Provider Portal

Altruista Health GuidingCare is a web-based care management tool for assigned providers to monitor rendered services, activities, quality measures and care plans for Blue Cross Community CentennialSM members. GuidingCare is accessible to existing Availity administrators and assigned users in the BCBSNM-branded Payer Spaces section in the Availity Portal. Learn More

Availity® Authorizations

Availity's Authorizations tool (HIPAA-standard 278 transaction) allows the electronic submission of inpatient admissions and select outpatient services handled by BCBSNM.  Learn More

Availity® Attachments: Submit Predetermination of Benefits Requests Online

Attachments is an online tool in the Availity Provider Portal that allows you to submit electronic predetermination of benefits requests handled by Blue Cross Blue Shield of New Mexico (BCBSNM). Learn More

Availity Eligibility and Benefits

It is important to verify membership and check coverage details for every patient at every visit, before you administer treatment.

To obtain fast, efficient, detailed benefits information for Blue Cross and Blue Shield members, you can use Availity's Eligibility and Benefits tool. This free online tool can provide you with co-payment, co-insurance, deductible, and other important information.

For additional details, refer to the Availity Eligibility and Benefits User Guide

Claim Inquiry Resolution

The Claim Inquiry Resolution tool allows you to communicate online with our customer advocates in some situations where previously a call or letter was required. Learn More

Claim Status Tool

The Availity® Claim Status Tool offers enhanced, real-time claim status functionality to help you manage and resolve claims processed by BCBSNM. Learn More

Clear Claim Connection

Clear Claim Connection is a web-based code auditing reference tool that mirrors BCBSNM edits (i.e., unbundling, mutually exclusive, and incidental). Learn More

Clinical Quality Validation (CQV) Application

Clinical Quality Validation (CQV) is a web-based application in the Availity® Provider Portal that allows providers to quickly comply with Healthcare Effectiveness Data and Information Set (HEDIS®) measures. Providers can electronically document their patient’s care and assessments to close quality HEDIS care gaps for BCBSNM members using CQV. Learn More

CoverMyMeds®

CoverMyMeds is an online tool for electronic completion and submission of benefit prior authorization (PA) requests for prescription drugs that are part of BCBSNM pharmacy PA program. Learn More

DNoA Connect

DNoA Connect  is a provider self-service tool where dental offices can conveniently connect to patient information for members with BlueCare DentalSM.

Electronic Claim Submission via Availity® Provider Portal

Availity’s Claim Submission tool allows providers to quickly submit electronic Professional (ANSI 837P) and facility, or Institutional (ANSI 837I) claims or encounters to Blue Cross and Blue Shield of New Mexico (BCBSNM), at no cost. Learn More

Electronic Clinical Claim Appeal Request via Availity®

The Dispute tool allows providers to electronically submit appeal requests for specific clinical claim denials through the Availity Portal. Learn More

Electronic Refund Management

Electronic Refund Management is an online tool that can help simplify your overpayment reconciliation and related processes. Learn More

Fee Schedules via Availity® (Professional Providers)

The Availity Fee Schedule tool allows professional providers participating with BCBSNM to electronically request a range of up to 20 procedure codes and immediately receive the contracted price allowance for the patient services you perform. Learn More

Medical Record Status Viewer

The Medical Record Status Viewer is an online application that allows providers to confirm receipt of the most recent medical records submitted by mail or fax to BCBSNM for claim processing. Learn more

Message This Payer Application 

The Message This Payer application in Availity® Essentials allows providers to send secure messages to BCBSNM for claim management questions and follow along with the conversation history. Learn More

National Drug Code (NDC) Units Calculator Tool via Availity®

The National Drug Code (NDC) Units Calculator is a user-friendly online tool that allows providers to convert applicable classified or specified Healthcare Common Procedure Coding System (HCPCS) or Current Procedural Terminology (CPT®) codes to NDC units. Learn More

Patient Care Summary

The Patient Care Summary tool uses claim-based information to provide you with a consolidated view of a patient's health care history at the point of care. Learn More

Patient Cost Estimator

The Availity® Patient Cost Estimator tool is an online member liability estimator that can help professional providers estimate a patient's potential out-of-pocket costs in real-time for office and outpatient services provided to BCBSNM members. Learn More

Patient ID Finder

The Availity® Patient ID Finder tool allows providers to obtain the BCBSNM patient ID number and group number by entering patient-specific data elements. Learn More

Provider Data Management (PDM)

Provider Data Management (PDM) is a web-based tool in Availity Essentials that allows professional providers to quickly update, validate and attest to the accuracy of their information on file with BCBSNM. Learn More

Remittance Viewer

The remittance viewer offers providers and billing services a convenient way to view and help reconcile claim data provided by BCBSNM in the 835 Electronic Remittance Advice (ERA). Learn More

Reporting On-Demand

The Reporting On-Demand application allows users to readily view, download, save and/or print the Provider Claim Summary (PCS) and other reports online, at no additional cost. Learn More

Responding to Quality and Risk Adjustment Medical Records Requests Online via the AvailityTM Provider Portal

The AvailityTM Medical Attachment tool allows providers to receive electronic quality and risk adjustment medical record requests from BCBSNM. Providers can upload and submit the necessary medical records to BCBSNM using the Medical Attachment option in the Claims & Payments menu through the Availity Provider Portal. Learn More