Preferred Site of Care Processing Issue for Blue Community HMOSM Member Claims

October 23, 2018

Due to a recent claim processing issue, some outpatient diagnostic claims for Blue Blue Community HMO members were underpaid. The affected claims were for diagnostic services such as labs, X-rays and high-tech radiology at professional settings between Jan. 1 and Sept. 17, 2018.

Blue Cross and Blue Shield of New Mexico (BCBSNM) began reprocessing impacted claims on Sept. 17, 2018. Once the adjusted claims are finalized, patients will receive updated Explanation of Benefits statements. Providers may receive additional payments and updated Provider Claim Summary or Electronic Remittance Advice reports. Providers who collected coinsurance and copayments at the time of service may owe refunds to patients who paid too much out of pocket.

We thank you for your patience and apologize for any inconvenience.