Affordable Care Act
The new health care law offers a host of coverage changes and opportunities beginning in 2014. Blue Cross and Blue Shield of New Mexico is committed to implementing coverage changes to comply with ACA requirements and to better meet the needs and expectations of you and your patients. Learn More.
ANSI 5010
The means by which BCBSNM exchanges member data with providers will change dramatically over the next several years. Upgrading ANSI 4010 to ANSI 5010 is required by a directive from the U.S. Department of Health and Human Services. That directive makes the same requirement of providers. Learn More.
Federal Employee Program®
For further information regarding specific FEP® Medical Policies or FEP Service Benefit Plan Brochure, please visit the FEP website to learn more.
Medical Policies
Medical Policies are based on research that provides evidence of scientific merit for a particular medical technology. In most cases, they are used as guidelines for coverage determinations in health care benefit programs. Explore more about Medical Policies.
Medical Policy and Prior Authorization for Out-of-Area Members
Medical Policy and Prior Authorization for Out-of-Area Members
Medical Records Documentation Standards
Medical Records Documentation Standards
Provider Reference Manual
The Provider Reference Manual is designed for ease of use while providing a comprehensive resource tool for your office. View the Provider Reference Manual
Reimbursement Calculations
Learn more about the the RBRVS relative values units to calculate your reimbursement.
Reimbursement Policies
Reimbursement policies (formerly known as clinical payment and coding policies) are based on criteria developed by specialized professional societies, national guidelines (e.g. Milliman Care Guidelines (MCG)) and the CMS Provider Reimbursement Manual.
Providing Reimbursable Telemedicine Services
BCBSNM encourages its contracted providers to furnish covered services to Medicaid members via qualifying and compliant interactive telecommunications systems and/or asynchronous store-and-forward technology, where clinically appropriate, especially to those members living in rural or frontier areas of the state (Telemedicine). The New Mexico Health Care Authority allows reimbursement for Telemedicine where program requirements are met. Learn More.