Government Programs: Improving Claim-Related Processes and EDI Transactions

September 17, 2018

The notice applies to providers submitting Blue Cross and Blue Shield of New Mexico (BCBSNM) government programs claims for Blue Cross Medicare Advantage HMOSM and Blue Cross Medicare Advantage PPOSM members only.

Providers submitting electronic claims for these government programs members may have previously experienced membership validation claim rejections and duplicate claim rejections. The duplicate claim rejections occurred when claims were resubmitted within 90 days of a previously processed claim that included the exact data for the same patient and date(s) of service.

Starting on Sept. 15, 2018, BCBSNM will implement claim processing changes that will help eliminate these claim submission rejections for government programs members. With this implementation, providers may encounter new claim submission edits for Professional and Institutional claims (837P and 837I transactions), which will improve accuracy and timeliness in processing. Additionally, electronic claims submitted by 5 p.m. (CT) should receive the payer acknowledgement response files on the same day.

As a reminder, Medicare Advantage electronic claims that are submitted through the Availity® Provider Portal must be submitted using Payer ID 66006. If these claims are submitted via direct data entry through the Availity Portal, providers should select the drop-down payer option of “Blue Cross Medicare Advantage.” Providers who are not registered with Availity should contact their clearinghouses to confirm the appropriate Payer IDs to be used when submitting government programs claims, as other clearinghouses may assign their own unique numbers.

If you have questions regarding an electronic claim rejection message, contact your practice management system software vendor, billing service or clearinghouse for assistance. For additional information on electronic options, refer to the Electronic Commerce page located in the Claims & Eligibility section of our website at

Availity is a trademark of Availity, LLC, a separate company that operates a health information network to provide electronic information exchange services to medical professionals. Availity provides administrative services to BCBSNM. BCBSNM makes no endorsement, representations or warranties regarding any products or services provided by third party vendors such as Availity. If you have any questions about the products or services provided by such vendors, you should contact the vendor(s) directly.