Medicaid
Blue Cross and Blue Shield of New Mexico's (BCBSNM's) Medicaid plan for 2014 is Blue Cross Community CentennialSM. This plan focuses on breaking down the financial, cultural, and linguistic barriers preventing low-income families and individuals from accessing health care. Blue Cross Community Centennial maintains and monitors a network of participating providers including physicians, hospitals, skilled nursing facilities, ancillary providers, and other health care providers through which members obtain covered services.
Participating providers are requested to submit claims within 90 days of the date of service, using the standard CMS-1500 or UB-04 claim form, or electronically. Services billed beyond 180 days from the date of service are not eligible for reimbursement.
Providers may not seek payment from the member for claims submitted after the 180-day filing deadline.
Mobility eXchange
View 
the latest news and updates from Mobility eXchange.
The Mobility eXchange Portal is available 24x7 for important notices, software updates, portal changes, troubleshooting issues and helpful tips for providers.
Providers can call the Mobility eXchange Support Line at 888-716-9528 between 8 a.m to 6 p.m. (PST) Monday through Friday. Providers can also email support at mconm@mobilityexchange.net.
- Electronic Visit Verification Training Communication and Registration Mar. 2, 2018
- Electronic Visit Verification Notification Dec. 1, 2017
- Electronic Visit Verification Implementation Frequently Asked Questions
- Electronic Visit Verification Implementation April 26, 2016 Notification
- Electronic Visit Verification Implementation June 1, 2016 Notification
- Electronic Visit Verification Implementation August 24, 2016 Notification
- Electronic Visit Verification Tablets Frequently Asked Questions
Effective February 20, 2017, Blue Cross and Blue Shield of New Mexico (BCBSNM) has contracted with eviCore healthcare (eviCore) to provide certain utilization management services for outpatient molecular and genomic testing and outpatient radiation therapy for our Blue Cross Community CentennialSM plan. eviCore is an independent company that provides specialty medical benefits management for BCBSNM.
Preauthorization Requirements
BCBSNM requires preauthorization (for medical necessity)* through eviCore for outpatient molecular and genomic testing and outpatient radiation therapy for the following benefit plans:
- Blue Cross Community Centennial
- All retail plans
- All fully insured small and large commercial groups
Refer to the eviCore implementation site and select the BCBSNM health plan for the applicable CPT/HCPCS code list and radiation therapy physician worksheets.
Contact Information
eviCore preauthorization's for outpatient molecular and genomic testing and outpatient radiation therapy can be obtained using one of the following methods:
- The eviCore Healthcare Web Portal is available 24x7. After a one-time registration, you are able to initiate a case, check status, review guidelines, view authorizations/eligibility and more. The Web Portal is the quickest, most efficient way to obtain information.
- Providers can call toll-free at 855-252-1117 between 7 a.m. to 7 p.m. (local time) Monday through Friday.
- More specific program-related information can be found on the eviCore implementation site .
* Preauthorization determines whether the proposed service or treatment meets the definition of medical necessity under the applicable benefit plan. Preauthorization of a service is not a guarantee of payment of benefits. Payment of benefits is subject to several factors, including, but not limited to, eligibility at the time of service, payment of premiums/contributions, amounts allowable for services, supporting medical documentation, and other terms, conditions, limitations, and exclusions set forth in the member's policy certificate and/or benefits booklet and or summary plan description. Regardless of any preauthorization or benefit determination, the final decision regarding any treatment or service is between the patient and the health care provider.
For information about reporting fraud, waste and abuse, refer to the Claims/Deficit Reduction Act section of the
CareLink New Mexico (CLNM) is a program to coordinate the integration of physical and behavioral health services for Medicaid beneficiaries with diagnoses of Serious Mental Illness (SMI) or Severe Emotional Disturbance (SED). The following organizations and facilities are available to create network relationships, which may be established through MOAs (required for primary care, local hospitals and residential treatment facilities) or other les formal processes.
- New Mexico Solutions (Bernalillo county)
- University of New Mexico Hospitals (Bernalillo County)
- Mental Health Resources (DeBaca county)
- Hidalgo Medical Services (Hidalgo and Grant counties)
- Guidance Center of Lea County (Lea county)
- Mental Health Resources (Quay county)
- Mental Health Resources (Roosevelt county)
- Kewa Pueblo Health Corporation (Sandoval county)
- Presbyterian medical Services (Sandoval county)
- Refer to the Registration Requirement in the Blue Cross Community Centennial section of the Provider Reference Manual.
- To join our network, follow the process for Network Participation.
- View a sample copy of the Medicaid Managed Care Medical Services Entity Agreement .
- Member handbook
- Preventive Care Guidelines for Adults
- Preventive Care Guidelines for Children
- Dental benefits for Medicaid members are administered by DentaQuest®. Learn more
- Vision benefits for Medicaid members are administered by Davis Vision® Learn more
- Transportation services are administered by LogistiCare® Learn more
- Special Beginnings – Our maternity program provides expectant moms with educational information and support through early pregnancy until 6 weeks after delivery Learn more
- Virtual Visits Now available for Blue Cross Community Centennial members
- Blue Cross Community Centennial Provider Reference Manual Note: To request a printed copy of the Blue Cross Community Centennial Provider Reference Manual, at no charge, please contact your Provider Network Representative.
- Medical Records Documentation Standards
- Notification of Birth form
- Preventive Care Guidelines
- Provider Finder®
- Provider Network Directory Note: This print directory is a list of doctors, hospitals and other providers in our network. The list is current as of the date it was published. For the most current information, use our online search above. The Provider Finder is updated daily.
- Provider Request for Appeal on Behalf of a Medicaid Member
- Referral and Transition of Care Request
- Sample ID Card
- Ombudsman Specialist - If you have a BCBSNM Medicaid patient who is having difficulty with care coordination or is unable to receive services believed to be covered under Blue Cross Community Centennial Care plan benefits, the Ombudsman Specialist may be able to help. Following New Mexico's Medicaid guidelines, the Ombudsman Specialist works to help resolve member issues.
- Provider Request for Appeal on Behalf of a Medicaid Member
Related Information
Pharmacy — view Medicaid drug lists, forms, preauthorization requirements and specialty pharmacy program information.
The Blue Cross Community Centennial training is for all provider types including behavioral health and long term care providers.
- Medicaid Claims Handling for Medicaid Members
- Cultural Competency Training
- Self-Directed Provider Training
- Blue Cross Community CentennialSM Provider Orientation
- Dual Special Needs Population Provider Training
- Fraud Awareness Training Tutorial
- Indian Tribal Urban Claims Reimbursement Process Provider Training
- Long-Term Care Services and Support Provider Orientation
Community agencies for Blue Cross Community Centennial (or NM Medicaid) are required to report any critical incidents of their patients/clients as outlined by the NM Human Services Department (HSD) in the following. Please reference the page linked below and the Helpful Documents at the bottom of that page.
In addition to Standard Medicaid Benefits, Blue Cross Community Centennial offers additional Value-Added Services (VAS) to help keep your patients and their families healthy.
