Provider Training and Continuing Education

In these webinar sessions, providers will learn how electronically submit prior authorization requests handled by BCBSNM using the Availity Essentials Authorizations tool. You will also learn how to access and use BlueApprovR via Availity Essentials to submit inpatient and outpatient medical/surgical, behavioral health and specialty pharmacy drug prior authorization requests as well as recommended clinical review (RCR) requests for medical/surgical and specialty pharmacy drugs.  

New and existing Availity Essentials users are highly encouraged to attend. To register for a complimentary webinar, select a session date & time below.

• Oct. 4, 2023 – 10 a.m. to 11:30 a.m.
• Oct. 11, 2023 – 10 a.m. to 11:30 a.m.
• Oct. 18, 2023 – 10 a.m. to 11:30 a.m.
• Oct. 25, 2023 – 10 a.m. to 11:30 a.m.
• Nov. 1, 2023 – 10 a.m. to 11:30 a.m.
• Nov. 8, 2023 – 10 a.m. to 11:30 a.m.
• Nov. 15, 2023 – 10 a.m. to 11:30 a.m.
• Nov. 22, 2023 – 10 a.m. to 11:30 a.m.
• Nov. 29, 2023 – 10 a.m. to 11:30 a.m.
• Dec. 6, 2023 – 10 a.m. to 11:30 a.m.
• Dec. 13, 2023 – 10 a.m. to 11:30 a.m.
• Dec. 20, 2023 – 10 a.m. to 11:30 a.m.
• Dec. 27, 2023 – 10 a.m. to 11:30 a.m.

BCBSNM is hosting complimentary webinars for providers to learn how to efficiently verify detailed claim status, submit clinical appeals, reconsiderations and send secure claim management questions online using the Availity Essentials Claim Status tool. Select your preferred date and time below to register for an upcoming session.

• Oct. 5, 2023 – 10 a.m. to 11:30 a.m.
• Oct. 12, 2023 – 10 a.m. to 11:30 a.m.
• Oct. 19, 2023 – 10 a.m. to 11:30 a.m.
• Oct. 26, 2023 – 10 a.m. to 11:30 a.m.
• Nov. 9, 2023 – 10 a.m. to 11:30 a.m.
• Nov. 16, 2023 – 10 a.m. to 11:30 a.m.
• Nov. 30, 2023 – 10 a.m. to 11:30 a.m.
• Dec. 7, 2023 – 10 a.m. to 11:30 a.m.
• Dec. 14, 2023 – 10 a.m. to 11:30 a.m.
• Dec. 21, 2023 – 10 a.m. to 11:30 a.m.
• Dec. 28, 2023 – 10 a.m. to 11:30 a.m.

Register for this session to better understand how the electronic transactions can work for your organization. In this session you will learn the importance of Manage My Organization, how to use the Patient Id Finder, key instruction on the newly updated Eligibility and Benefits capability as well as the Electronic Predetermination process.

• Oct. 17, 2023 – 10 a.m. to 11 a.m.
• Nov. 21, 2023 – 10 a.m. to 11 a.m.
• Dec. 19, 2023 – 10 a.m. to 11 a.m.

We offer the following free behavioral health webinars. Doctors (MDs and DOs), nurses, physician assistants, physical and occupational therapists, and psychologists earn one continuing medical education (CME) credit for each course attended, unless otherwise noted. Social workers and mental health counselors (LPC, LCPC, LPCC) earn one continuing education unit (CEU) per course. 

Continuing Education Credits: Recorded Webinars

Sign in (registration required) to view recordings of our previous webinars and earn CME/CEU credit: 

These courses are available:

• Bipolar Disorder: Diagnosis and Treatment, recorded February 2023 (1.5 CME/CEU)
• Comorbid Behavioral Health and Physical Health Conditions, recorded October 2021
• Depression in a Primary Care Setting, recorded June 2021
• Diabetes and Behavioral Health, recorded April 2022
• Differential Diagnoses of Depression: Assessment and Treatment, recorded March 2022
• Maternal Mental Health: Pregnancy and Postpartum, recorded April 2023 
• Opioid Use Disorder, recorded August 2021
• Substance Abuse: Coordinating Care and Improving Follow-Up, recorded May 2022
• Suicide Prevention with the Military Community, recorded November 2022 (1.5 CME/CEU)
• Synthetic Opioids and the Opioid Crisis, recorded April 2023

The webinars offer introductory training and a high-level overview.

_{The New Mexico Osteopathic Medical Association (NMOMA) is accredited by the American Osteopathic Association to provide osteopathic continuing medical education for physicians. NMOMA designates this program for a maximum of 1 AOA Category 1-A credits (or 1.5 if noted) and will report CME and specialty credits commensurate with the extent of the physician's participation.}

_{Social Work CEUs Approved by NASW-NM. The Licensee must maintain proof of continuing education courses taken for the past four (4) years. The New Mexico Regulations and Licensing Department, Boards and Commissions, Social Work Licensing Board reserves the right to audit a licensee’s continuing education records as it deems necessary. This event has been approved for a total of 1 CEU (or 1.5 if noted).}

_{Physicians, nurses, physician assistants, nurse practitioners and psychologists can use AOA Cat 1-4 credit toward licensure. Social workers and mental health counselors (LPC, LCPC, LPCC) can use the Social Work CEU credit toward licensure.}

_{The above material is for informational purposes only and is not intended to be a substitute for the independent medical judgment of a physician. Physicians and other health care providers are encouraged to use their own best medical judgment based upon all available information and the condition of the patient in determining the best course of treatment.}

Learn how to access and use BlueApprovR via Availity Essentials to submit and secure real-time approvals for specialty pharmacy drug, behavioral health clinical evaluation and medical surgical prior authorization requests as well as recommended clinical review (RCR) requests for medical/surgical and specialty pharmacy drugs for many BCBSNM commercial members.

Register for an instructor-led webinar session by selecting your preferred date and time below: 

• Nov. 2, 2023 – 12 p.m. to 1 p.m.
• Nov. 9, 2023 – 12 p.m. to 1 p.m.
• Nov. 16, 2023 – 12 p.m. to 1 p.m.
• Nov. 30, 2023 – 12 p.m. to 1 p.m.
• Dec. 14, 2023 – 12 p.m. to 1 p.m.
• Dec. 21, 2023 – 12 p.m. to 1 p.m.
• Dec. 28, 2023 – 12 p.m. to 1 p.m.

Attend free training sessions on how to submit requests for Carelon Prior Authorizations. Refer to the Carelon On-demand training page  for available sessions.

BCBSNM is hosting complimentary webinars for providers to learn how to electronically submit Claim Reconsiderations for situational finalized claim denials (including BlueCard^® out-of-area claims). To register for a training session, select your preferred date and time below.     

• July 24, 2023 – 10 a.m. to 11 a.m. MST
• July 25, 2023 – 1 p.m. to 2 p.m. MST
• July 26, 2023 –10 a.m. to 11 a.m. MST
• July 27, 2023 – 1 p.m. to 2 p.m. MST
• July 28, 2023 – 10 a.m. to 11 a.m. MST

Join members of our Coding Compliance team for free webinars. They will present information from official coding resources to improve specificity and accuracy in coding, and help close gaps in patients’ care. Learn more about our coding webinars. 

BCBSNM is offering the courses listed below to earn continuing education credit. These webinars are offered at no cost through Quality Interactions, a separate company that provides cultural awareness training to health care professionals.  

Course Offerings

Select the link for accreditation information and course overviews:

• Recognizing and Responding to Implicit Bias (CME/CEU/CCM/CDE)
• Cross-Cultural Care in Mental Health and Depression (CME/CEU/CCM/LSW)
• Culturally Competent Care for the Medicare Population (CME/CEU/CCM)
• Improving Adherence in Diverse Populations (CME/CEU/CCM/LSW/ACPE)
• Test Your Skills for Clinicians (option A) (CME/CEU/CCM)
• Test Your Skills for Clinicians (option B) (CME/CEU)

How to Attend

• Enter your email address and create a password on the Quality Interactions website.
• Watch your email for a link to your new account profile. Complete your profile and enter Learn2022 as your Org ID.

The courses are self-paced. Find instructions and get help online.

_{Quality Interactions is a separate company that provides cultural competency training to health care professionals. BCBSNM makes no endorsement, representations or warranties regarding third party vendors and the products and services they offer.}

• Electronic Funds Transfer (EFT) — a secure method of claims payment
• Electronic Remittance Advice (ERA) — an electronic file that explains claim payment and remittance information
• Electronic Payment Summary (EPS) — an electronic print image of the Provider Claim Summary

Learn more about these electronic solutions

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

The primary mission of BCBSNM Special Investigations Department (SID) is to identify, prevent, investigate, and stop potential fraudulent activities. The SID is committed to fighting fraud, reducing health care costs, and protecting the integrity of the BCBSNM provider network.

Each year billions of dollars are inappropriately spent due to health care fraud, waste, and abuse which contributes to the rising cost of health care for all Americans. In response to this problem, BCBSNM has an established SID – one of the most aggressive and effective health care fraud investigation programs in the industry.

To help you understand what health care fraud is, how it affects your practice, and how you can report health care fraud to the SID, BCBSNM offers a free online Fraud Awareness Training Tutorial .

BCBSNM considers fraudulent billing to include, but not be limited to:

• Deliberate misrepresentation of the services provided to receive payment for a non-covered service.
• Deliberately billing in a manner which results in a reimbursement greater than what would have been received if the claim was properly filed.
• Billing for services that were not rendered.

Additionally, the SID maintains a 24-hour fraud hotline, through which you can report any suspicions of fraud. All calls are confidential, and you may report your information anonymously. To file a report, call the hotline at 1-800-543-0867 (24/7) or go to bcbsnm.com/sid/reporting.

Our IVR system uses voice recognition technology so that you can obtain automated information on member eligibility, benefits or to adjust a claim. All you need to do is speak your request — the IVR does the rest. Learn More

2019 Commercial and Medicare Plans Provider Training

2020 Medicare Provider Training

Annual Provider Training

Annual Provider Training is a requirement for all Medicaid providers. This information may be of interest and be beneficial for all providers. Please contact your Provider Network Representative if you have any questions.

• 2023 Blue Cross Community Centennial - Behavioral Health Provider Training
• 2023 Blue Cross Community Centennial - Physical Health Provider Training
• 2023 CMS and Albuquerque Area IHS Training
• 2023 CMS and Navajo Nation IHS Training
• 2023 Home and Community Based Service (HCBS) Final Settings Rule Training

Dual Special Needs Population (DSNP) Model of Care Provider Training

The Centers for Medicare & Medicaid Services (CMS) requires all Special Needs Plans (SNPs) to provide an annual training on the Model of Care (MOC) for all providers who provide services to SNP members. To ensure that you receive credit for completing the training, please reach out to your location Provider Network Representative at 1-800-567-8540.

Dual Special Needs Population (DSNP) Model of Care Provider Interactive Training

Dual Special Needs Population (DSNP) Model of Care Provider Training

Cultural Competency Training

Annual Cultural Competency Training is required by the New Mexico Human Services Department for all providers contracted within a New Mexico Medicaid network, like Blue Cross Community Centennial. Please have your 10-digit NPI number ready when starting the training or attestation below. Do not use any dashes or spaces when entering your NPI, and make sure your NPI is entered correctly before proceeding with the rest of the training or attestation.

• Cultural Competency Training
• Cultural Competency Training Attestation

Attend our free webinars on measures to track and improve our members’ care. Learn more about our quality improvement webinars and continuing education credits. 

These online tools offer providers and billing services a convenient way to view claim detail information from the 835 Electronic Remittance Advice (835 ERA) and the Provider Claim Summary (PCS). Attend a webinar to learn how to gain or grant access, conduct a search, view general and payer specific information, and save or print results.

To register, select a webinar date and time from the list below:

• Oct. 19, 2023 – 12 p.m. to 1 p.m.
• Nov. 16, 2023 – 12 p.m. to 1 p.m.
• Dec. 21, 2023 – 12 p.m. to 1 p.m.