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Rendering, Ordering, Attending and Referring Providers Must Enroll with NM Medicaid for Blue Cross Community CentennialSM Claims

May 11, 2018

Blue Cross and Blue Shield of New Mexico (BCBSNM) has previously communicated the requirement for billing and rendering providers to enroll in the New Mexico (NM) Medicaid program. Effective for dates of service on and after Sept. 1, 2018, and in accordance with the requirements detailed in the New Mexico Human Services Department (HSD) Supplements 17-07 , 17-08 , and 17-09 released on Sept. 11, 2017, the appropriate rendering, ordering, attending and referring providers listed on all Blue Cross Community Centennial claims must be enrolled with (NM) Medicaid. If these providers are not enrolled with NM Medicaid, (BCBSNM) will deny Blue Cross Community Centennial claims for dates of service on or after Sept 1, 2018.

This requirement ensures that rendering, ordering, attending, and referring providers can always be identified on claims and encounter reports by having their NPI numbers registered in the Medicaid provider file. This requirement also assures BCBSNM’s encounter submission data will be accepted by the Medical Assistance Division (MAD).

You may enroll with NM Medicaid online, or check your enrollment status at:
https://nmmedicaid.acs-inc.com/webportal/ Learn more about third-party links

As previously communicated, effective for claims with dates of service on or after July 1, 2018, providers must include the appropriate rendering, ordering, attending and referring providers on all Blue Cross Community Centennial claims. If this detailed information is not included in the claim submission, BCBSNM will deny these claims.

Please refer to the HSD Supplements for situations which may be exempt from the requirement to list rendering, ordering, attending, and referring providers on these claims.

For more information about including the appropriate rendering, ordering, attending and/or referring provider information on Blue Cross Community Centennial claims, please refer to the HSD Supplements above or contact your Provider Network Representative at (505) 837-8800 or toll free at 1-800-567-8540.

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