Network Participation

We contract with physicians, facilities and other health care professionals to ensure that our members receive accessible, cost-effective and quality health care services.

Providing information about languages you or your office personnel speak is voluntary. If disclosed, the information will not be used to make adverse contracting or credentialing decisions and will be used in accordance with applicable law.

  • How to Join the BCBSNM Provider Networks

    Steps To Join

    Step 1 — Complete the Provider Onboarding Form, any additional forms listed below and validate your Medicaid registration, if applicable. 

    Complete the Provider Onboarding Form and any additional required forms applicable based on the provider type and services provided.

    Medicaid providers: If applying to join our network, you must be registered with the State of New Mexico Medicaid program. Review the Medicaid Provider Reference Manual for details. Complete and submit the Disclosure of Ownership and Control Interest Form with the Provider Onboarding Form. All highlighted sections in the form are required.

    Ancillary and facility providers: All ancillary and facility providers must complete the state-mandated MCO Facility/Organizational Credentialing Application, the Participating Provider Interest Form and the Provider Onboarding Form. Refer to the Ancillary/Facility Credentialing Checklist for a list of all required supporting documentation.

    Behavioral health providers: Complete the Behavioral Health Designation Checklist, Areas of Expertise Form and Telemedicine/Telehealth Provider Attestation, and submit them with the Provider Onboarding Form.

    Long-term care providers: Complete the Long-term Care Designation Checklist and Telemedicine/Telehealth Provider Attestation, and submit them with the Provider Onboarding Form.

    Physical health and other specialty providers: Complete the Provider Designation Checklist and Telemedicine/Telehealth Provider Attestation, and submit them with the Provider Onboarding Form.

    Urgent care center: Complete the Urgent Care Center Attestation and submit it with the Provider Onboarding Form.

    Step 2 — Submit a signed contract and become credentialed.

    If you meet eligibility requirements, you will be sent a contract for participating in our provider networks and the credentialing process initiated by BCBSNM. Please refer to the Getting Credentialed section on this page for additional details related to completing your credentialing application.

    Providers who participate in our networks are required to complete the credentialing process as necessary, prior to acceptance into our networks.

    Our credentialing requirements are derived from, and in compliance with, applicable New Mexico and National Committee for Quality Assurance credentialing standards.

    Step 3 — Welcome to BCBSNM contracted network(s).

    After we review your Provider Onboarding Form and your signed contract, and you complete the credentialing process, we will let you know if you are accepted into our networks. If you are accepted, you will receive a welcome letter with your network effective date.

    Step 4 — Get connected.

    Once you are part of our networks, we strongly encourage you to use all available electronic options for electronic data interchange transactions to help ensure timeliness, accuracy and security of claims-related information including:

    • Availity® Essentials
    • EDI transactions
    • Electronic funds transfer and electronic remittance advice

    Credentialing Status Checker

    To check the status of your credentialing process, enter your NPI or license number in our Credentialing Status Checker.

    Case Status Checker

    If you have completed a Provider Onboarding Form, you can check the status of your application by entering the case number you received in your confirmation email in our Case Status Checker.

    1Meeting criteria for, or completion of, one or more step(s) is not a guaranty of participation in any network with BCBSNM, nor does it confer any rights upon the applicant. No communication from BCBSNM during these steps constitutes an offer capable of acceptance. Participation requires BCBSNM's counter-execution of a participation agreement, as to which BCBSNM reserves unfettered discretion to the fullest extent allowed by applicable law.

    Note: A provider record with BCBSNM does not automatically activate the NM network. Claims will be processed out-of-network, until the provider has applied for network participation, been approved and activated in the network.

    If you are interested in contracting with BCBSNM please contact us at 505-837-8800 or 1-800-567-8540.

  • Network Adequacy Exception Process

    Provider Type/Specialty Notice: BCBSNM is not accepting interest forms for the provider type/specialties panels and geographic areas listed below. This does not apply to practitioners joining existing contracted groups.

    Bernalillo County (All Lines of Business)

    • Advanced Chiropratic (Except Medicaid)
    • Chiropratic (Except Medicaid)

     

    Statewide (All Lines of Business)

    • Durable Medical Equipment
    • Home Infusion/Specialty Pharmacy
    • Labs
    • Massage Therapist (Except Santa Fe County)
    • Naprapathy (Except Santa Fe County)
    • Naturopathy (Except Medicaid)

     

    Network Adequacy Exception Requests: Exception requests may be submitted using the Network Adequacy Exception Request form and emailed/faxed to BCBSNM for review.

  • Getting Credentialed

    BCBSNM requires providers to use the Council for Affordable Quality Healthcare® (CAQH) for initial credentialing and recredentialing. ProViewTM (a free online service, allows providers to fill out one application to meet the credentialing data needs of multiple organizations. This solution helps to ensure the accuracy and integrity of our provider database.

    Note: BCBSNM's requirement of use of ProView does not apply to providers participating through delegated credentialing agreements/contracts.

    Activating Your ProView Registration with CAQH*

    Once your provider record has been set up and you have requested to participate in the BCBSNM provider networks, you will need to be credentialed. Participating providers must have a CAQH provider identification (ID) to register and begin the credentialing process.

    First Time Users

    • If you are not registered with CAQH — When you obtain a BCBSNM provider record for claim payment and submit a current signed BCBSNM contract/agreement, BCBSNM will add your name to its roster with CAQH. CAQH will then mail to you the access and registration instructions, along with your personal CAQH provider ID, allowing you to obtain immediate access to ProView via the internet.
    • When you receive your CAQH provider ID, go to the CAQH website to register.
      Note: Registration and completion of the online application is free. Once registration is completed, you may use your ProView user name and password to log in at any time.

    Existing Users

    If you are already registered with CAQH and completed your ProView application through your participation with another health plan, log in to ProView and add BCBSNM as one of the health plans that can access your information. Refer to Authorization instructions in the CAQH Reference Guide.

    Completing the Application Process

    When you are ready to begin entering your data, log in to ProView with your user name and password.

    If you have any questions about accessing ProView, contact the CAQH Support Desk for assistance.

    CAQH Contact Information

    • Help Desk: 888-599-1771
    • Help Desk email address: caqh.uphelp@acsgs.com
    • Help Desk hours: 5 a.m. – 7 p.m., MT, Monday – Thursday and 5 a.m. – 5 p.m., MT, Friday

    View the 5-minute tutorial for completing the ProView application.

    View the application process.

    See the BCBSNM Provider Reference Manual, Section 16 – Credentialing

    Note: BCBSNM may need to supplement, clarify or confirm certain responses on your application with you. Therefore, you may be required to provide us with supplemental documentation in some situations, in addition to the information you submit through ProView.

    Verify separately for provider directory: Entering and attesting to data in CAQH ProView doesn’t verify the information needed for the federal Consolidated Appropriations Act (CAA). The CAA requires that certain directory information be verified every 90 days, even if your data hasn’t changed since you last verified it. We recommend that professional providers use Availity® Essentials Provider Data Management feature to quickly verify your directory information with us and other insurers every 90 days. Facilities must use the Demographic Change Form to verify their directory data. Learn more on our Verify and Update Your Information page.

    Credentialing Status Checker

    To check the status of your credentialing process, enter your NPI or license number in our Credentialing Status Checker.

    For Hospitals and Facilities including Behavioral Health and Ancillary Providers

    For Office-based or Professional Providers: If you are a provider that requires one of the following additional forms listed below, you must complete and forward by fax to 866-290-7718 or 505-816-2688.

     

  • Credentialing for Office Based or Professional Providers

    Please see the "Getting Credentialed" section above for credentialing information for all provider types. 

  • Credentialing for Hospital or Facility Based Providers

    Under the Consolidated Appropriations Act (CAA) of 2021, all contracted providers must be listed in the provider directory. If you're a contracted provider, including those who are facility-based but have not been credentialed with BCBSNM, you must become credentialed with us to be listed in our Provider Finder.

    Please see the "Getting Credentialed" section above for credentialing information for all provider types. 

  • Update Your Information

    Keeping your information current with CAQH and BCBSNM is your responsibility.

    BCBSNM members rely on the accuracy of the provider information in our online Provider Finder® . This is why it's very important that you inform BCBSNM whenever any of your practice information changes. If you are a participating provider with BCBSNM, you may request most changes online by emailing us.

    CAQH ProView:
    You will be sent automatic reminders from CAQH to review and attest to the accuracy of your data. Use ProView to report any changes to your practice.

    Verify Separately for Provider Directory

    Attesting to data in CAQH ProView doesn’t verify the information needed for the federal Consolidated Appropriations Act (CAA). The CAA requires that certain directory information be verified every 90 days, even if your data hasn’t changed since you last verified it. We recommend that professional providers use Availity® Essentials to quickly verify your directory information with us and other insurers every 90 days. Facilities must use the Demographic Change Form to verify their directory data. Learn more on our Verify and Update Your Information page.

  • Recredentialing

    The process of recredentialing is identical to that for credentialing, and is consistent with National Committee for Quality Assurance and State of New Mexico requirements.

    If you are not currently registered with CAQH, BCBSNM will add your name to its roster with CAQH. CAQH will then mail to you the access and registration instructions, along with your personal CAQH provider ID, allowing you to obtain immediate access to ProView via the internet to complete and submit your application. This will help you to conform to the requirements of your provider contract/agreement to continue your participation with BCBSNM's networks.

    If you are an existing user of CAQH, you are required to review and attest to your data once every 4 months. At the time you are scheduled for recredentialing, BCBSNM will send your name to CAQH to determine if you have already completed the ProView credentialing process and authorized BCBSNM or selected "global authorization". If so, BCBSNM will be able to obtain current information from the ProView database and complete the recredentialing process without having to contact you.

    If you are contracted for the Medicaid network, a provider disclosure must be completed and submitted with your current documents to CAQH as part of the complete application packet.

    Note: If you are a provider that requires one of the following additional forms listed below, you must complete and forward by fax or mail to BCBSNM as indicated below.

    Forward applicable completed form(s) to BCBSNM:

    Fax to: 1-866-290-7718 or 1-505-816-2688 (preferred method)

    or

    Mail to:
    Blue Cross and Blue Shield of New Mexico
    Network Services Department
    P.O. Box 660058
    Dallas, TX 75266-0058

    Recredentialing Decision Notification

    Upon completion of the recredentialing process, providers are considered approved unless notified otherwise. Notifications of the determinations other than approval will be mailed within 10 business days of the decision.

  • Frequently Asked Questions

    CAQH Frequently Asked Questions

    ProView Frequently Asked Questions

  • Case and Credentialing Status Checker

    Case Status Checker

    If you have completed a Provider Onboarding Form, you can check the status of your application by entering the case number you received in your confirmation email in our Case Status Checker.

    Credentialing Status Checker

    To check the status of your credentialing process, enter your NPI or license number in our Credentialing Status Checker.

Related Resources:

*The Council for Affordable Quality Healthcare, Inc. (CAQH) is a not-for-profit collaborative alliance of the nation's leading health plans and networks. The mission of CAQH is to improve health care access and quality for patients and reduce administrative requirements for physicians and other health care providers and their office staffs.

CAQH is solely responsible for its products and services, including ProView.