Standards and Requirements

Affordable Care Act (ACA)

The new health care law offers a host of coverage changes and opportunities beginning in 2014. Blue Cross and Blue Shield of New Mexico (BCBSNM) 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.


On Jan. 16, 2009, the U.S. Department of Health and Human Services released a final rule mandating that everyone covered by the Health Insurance Portability and Accountability Act must transition from ICD-9 code sets and adopt ICD-10-CM diagnosis codes and ICD-10-PCS procedure codes. 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 Preathorization for Out-of-Area Members

Medical Policy and Preauthorization for Out-of-Area Members

Medical Records Documentation Standards

Medical Records Documentation Standards 

Provider Reference Manual

Provider Reference Manual Table of Contents with Changes and Updates Preface
View the Provider Reference Manual 

Reimbursement Calculations

Learn more about the the RBRVS relative values units to calculate your reimbursement.

Clinical Payment and Coding Policies

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.