Network Participation



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Blue Cross and Blue Shield of New Mexico (BCBSNM) appreciates your interest in becoming a contracting provider with our health care organization. We contract with physicians, facilities and other health care professionals to ensure that our members receive accessible, cost effective and quality health care services.


Note: Effective 7/1/2016, all facilities who wish to join the Medicaid network, must also fill out the MCO Facility/Organizational Credentialing Application Adobe Acrobat PDF in addition to the Participating Provider Interest Form outlined in the below steps, "How to Join the BCBSNM Provider Networks".




Blue Cross and Blue Shield of New Mexico (BCBSNM) welcomes you to apply to join our provider networks. We contract with health care professionals, facilities and other providers to form our provider networks which are essential for delivering quality, accessible and cost-effective health care services to our members.


We developed a new process for professional provider groups and solo practitioners to make joining our networks even easier. Professional provider groups and solo practitioners will need to follow the steps outlined below to apply to join. We look forward to working with you!


FIVE EASY STEPS TO JOIN!

  • Step 1Complete an application (Professional Provider Groups and Solo Practitioners).

    To apply to join our networks, you will need to complete the Provider Onboarding Form .

  • Step 2 — Submit a signed contract.

    If you meet eligibility requirements, you will be sent a contract for participating in our provider networks.

  • Step 3 — Become credentialed.

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

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

  • Step 4 — Review Process.

    After we review your Provider Onboarding Form, 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 5 — Get connected.

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

    • Availity
    • Electronic Data Interchange (EDI) Transactions
    • Electronic Funds Transfer (EFT) and Electronic Remittance Advice (ERA)

Facilities including Behavioral Health and Ancillary Providers

Complete the Participating Provider Interest Form for Facilities Adobe Acrobat PDF

 

Urgent Care Centers

Urgent Care Centers must also complete the urgent care center attestation Adobe Acrobat PDF

 

New Mexico Medicaid Atypical Providers

Complete the Participating Provider Interest Form for New Mexico Medicaid Atypical Providers Adobe Acrobat PDF

 

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 .

 

Disclosure of Ownership and Control Interest Form

In compliance with 42 CFR 457.935, 42 CFR §455.104, $455.105, and §455.106, providers/disclosing entities are required to disclose including, but not limited to, information regarding (1) the identity of all persons with an ownership or control interest in the provider/disclosing entity, or in any subcontractor in which the provider/disclosing entity has a direct or indirect ownership of 5 percent or more including the identity of managing employees, and other disclosing entities; (2) certain business transactions and significant business transactions between the provider/disclosing entity and subcontractors/wholly owned suppliers; and (3) the identity of any person with an ownership or control interest in the provider/disclosing entity or who is an agent, or a managing employee of the provider/disclosing entity that has ever been convicted of any crime related to that person's involvement in any program under the Medicaid, Medicare, or Title XX program (Social Services Block Grants), or XXI (State Children’s Health Insurance Program) of the Social Security Act since the inception of those programs.

Any authorized/designated representative of the provider/disclosing entity may complete and sign this form on behalf of the provider/disclosing entity.

Complete the Disclosure of Ownership and Control Interest Form Adobe Acrobat PDF

 

1Meeting criteria for, or completion of, one or more step(s) is not a guaranty of participation in any BCBSNM network, 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.

 

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


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 or are solely practicing in a hospital based environment.


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 Blues 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.


BCBSNM requires full credentialing of the physicians and other professional providers listed below for participation in the networks.


  • MDs and DOs
  • DDSs (oral and maxillofacial surgery)
  • licensed physical therapists and occupational therapists
  • optometrists, audiologists, speech and language pathologists
  • behavioral health providers*
  • physician assistants, surgical assistants, advanced practice nurses, certified midwives, registered nurse first assistants
  • podiatrists
  • chiropractors
  • acupuncturists

 

* The licensing board for psychologists (PhDs) does not provide a quick verification method of a provider's license. PhDs will be fully credentialed and made effective after credentialing approval.


Note: 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.

 

 


Follow the table below to submit a request for contracting/participating in the New Mexico networks.

  • Eligible specialties include, but are not limited to, anesthesia, emergency medicine, radiology, pathology, neonatology and hospitalist.
  • The facility based application only applies to providers who practice exclusively in a facility, either a hospital or a freestanding outpatient facility.

 

Hospital or facility based providers must have the following:

  • hospital privileges
  • type 1 NPI #
  • NM State Board of Medical Examiners license (temporary permit is acceptable) or appropriate NM licensure
  • certificate/AANA# (applicable to certified registered nurse anesthetist providers only)

Note: A BCBSNM provider record 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 provider is ….

THEN ….

with a medical group that is currently contracted with NM networks.

a solo practitioner or medical group interested in contracting as a facility based provider with NM network.


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.


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

or

Mail to:
Blue Cross and Blue Shield of New Mexico
Network Services Department
P.O. Box 27630
Albuquerque, NM 87125-7630


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 .

 

*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.