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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 Learn more about third-party links 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.



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




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.


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.


Highlighted Services

Such services are funded in part with the State of New Mexico.

Blue Cross and Blue Shield of New Mexico, a Division of Health Care Service Corporation, a Mutual Legal Reserve Company, an Independent Licensee of the Blue Cross and Blue Shield Association