Reimbursement Calculations

The Blue Cross and Blue Shield of New Mexico (BCBSNM) maximum allowable fee schedule utilizes certain aspects of the Medicare Resource Based Relative Value System (RBRVS) methodology. BCBSNM has recently reviewed the 2016 BCBSNM Maximum Allowable Fee Schedule and determined that an update to the Fee Schedule is appropriate. Additionally, BCBSNM determined after reviewing Maximum Allowable Fee Schedules for Blue Advantage HMO Network, Blue Community HMO Network, and, Blue Preferred Network that updates to those fee schedules for dates-of-service on and after September 1, 2017 are appropriate as well. New codes will continue to be added to the system. Pricing for injectable drugs will be updated quarterly.

Therefore, for dates of service on and after Sep. 1, 2017, your reimbursement will no longer be calculated using the 2016 Maximum Allowable Fee Schedule that was effective for BCBSNM on Sept. 1, 2016, but rather, BCBSNM’s updated Maximum Allowable Fee Schedule as described above.

To evaluate the changes in your reimbursement that may result from BCBSNM's updated Maximum Allowable Fee Schedule, you may receive an interactive copy of the Schedule by emailing your request to FeeScheduleRequests@bcbsnm.com.

Please be sure to reference "Request for Interactive BCBSNM Maximum Allowable Fee Schedule" in the subject line along with the lines of business for which you are requesting an updated fee schedule. Please include your Tax ID in the body of the message. These Schedules are confidential and proprietary information and must be maintained as such per your Agreement.

BCBSNM values your participation in our programs and welcomes your input. If you have any questions or concerns, contact the Network Services Department at (505) 837-8800 or (800) 567-8540 for assistance.