Bcbsnm provider phone number. , if more than one PDO was given to you for different date BCBSNM Created Date: Providers can also request a hard copy of the reference manual at no charge from their Provider Network Representative. Shop for Vision Plans. Get phone numbers and addresses for Medicare, provider, group, individual and family. If you have coverage through your employer, please see “Group Plans” below. This tool permits registered Availity users to readily view, download, save and/or Print Electronic Claim Submission via Availity ® Provider Portal. UnitedHealthcare Oxford Health Plan 800-666-1353 If you have any questions, please contact the BCBSNM Health Services Department at 800-325-8334. You may also contact BCBSNM Health Care Management at 505291-3585 or 1-800-325-- 8334. When a provider has a contract to provide services to Centennial Care members, those providers are in the BCBSNM Centennial Care network. Doctors in your plan network *. Health plan support All Savers® Health Plan 800-291-2634. BCBSNM Provider One Call Phone (855) 610-9833 Blue Cross Community Centennial Behavioral Health Phone (800) 693-0663 Blue Cross Community Centennial Bilingual (English-Spanish) Contact Name Phone/E-mail/URL; Provider Service Unit. Check Your Provider Network. Physicians and professionals: 1-800-344-8525; Hospitals or facilities: 1-800-249-5103 You may need to contact your clearinghouse if they use a different BCBSNM payer ID. Individuals & Families; Medicare; Employers; Explore affordable health care plans Learn More. Please continue to contact BCBSNM for all New Mexico Medicaid prior authorization requests. Provider Claim Summary User Guide 1) Getting Started Aug. Find the information you need to contact BCBSNM. Provider Name Email Address: NPI Number: Phone Number If you have prescription drug coverage through Blue Cross and Blue Shield of New Mexico (BCBSNM), this information can help you and your doctor get the most from your prescription drug coverage. NM Uniform Prior Authorization Form : Use for services requiring prior authorization Participating providers are requested to submit claims within 90 days of the date of service, using the standard CMS-1500 or UB-04 claim form, or electronically. have a Summary of Benefits, please contact a BCBSNM Customer Service Advocate (the phone number is at the bottom of each page of this benefit booklet). A Division of Health Care Service Corporation, a Mutual Legal Reserve Company, an Independent Licensee of the Blue Cross and Blue Shield Association . Be sure to include your name, direct contact information and Tax ID or Billing NPI. The BCBSNM Medicaid plan focuses on breaking down the financial, cultural, and linguistic barriers preventing low You may need to contact your clearinghouse if they use a different BCBSNM payer ID. Check your benefits booklet for details. Prior Authorization and Step Therapy Participating providers are requested to submit claims within 90 days of the date of service, using the standard CMS-1500 or UB-04 claim form, or electronically. com Contact List for In-Network Medicaid Providers CONTACT NAME PHONE / FAX / EMAIL / URL BCBSNM Quality Improvement Department Phone (855) 699-0042 Email Blue Cross Blue Shield of New Mexico is committed to giving health care providers the support and assistance they need. Centennial Care members can choose to see any provider in the BCBSNM Centennial Care Effective Feb. In-Network Provider Options; Breastfeeding Counseling; Please enter a valid phone number. To return to our website, simply close the new window. Claims will be processed out-of-network, until the provider has applied for network participation, been approved and activated in the network. Updates made to the Blue Cross Community Centennial Section of the BCBSNM Provider Reference Manual; Required Cultural Competency Training Available Online; Reminder: Update your Enrollment Information February 2021 — Read these articles and more COVID-19 Information for Providers; Documenting and Coding Guidance for Atrial The state determines who qualifies for Medicaid based on federal guidelines. Fully insured plans have this text on the back of the ID card: “BlueCross BlueShield of New Mexico, a Division of Health Care Service Corporation, a Mutual Legal Reserve Company, an These tools and services can help you use your Blue Cross and Blue Shield of New Mexico (BCBSNM) membership. Sales Questions and Additional Plan Information: 1-888-809-1135. Register with Availity to verify eligibility and benefits, submit prior authorization requests, obtain claim status, view provider claim summaries and more. Health care providers, find a Blue Cross NC phone number for info on eligibility, benefits and claims status, plus medical policies, contract updates and more. Box 660058. Blues Provider ReferenceManual 1 – Contact . Annual Provider Training is a requirement for all Medicaid providers. Ancillary Service Center For ancillary product support, submit an online inquiry or call 1-877-723-5697. 2020 Medicare Provider Training. Based on your location, you may be able to get in Following are some tips for billing midwifery services furnished to BCBSNM Medicaid Members in licensed birth centers and as home births. In order to process this payment, you will be redirected to Alacriti's secure payment site, OrbiPay. 2024 Policy Documents. Providers; Company Information; Feedback; Language Assistance; En español; If you provide a phone number, an agent may call you to make sure that you received the information and to answer any questions that you might have. Dallas, TX 75266-0058. Search for doctors, dentists, hospitals and other health care providers in the commercial networks. Providers may submit the NM Uniform Prior Authorization form electronically through CoverMyMeds The phone number on your BCBSNM member ID card; The Blue Access ® Internet Help Desk at 888-706-0583; Representatives are available 24 hours a day, 7 days a week. Submit one PDO per claim; i. If your provider needs to contact us, they may call the BCBSNM Provider Services Unit at 1-800-693-0663. The appearance of a benefit product logo is not a guarantee of payment. Toll-free: 800-288-2227. Eye Exams Help Your Health. Please have the care provider’s full name, Tax ID, and National Provider Identifier (NPI) available. CAQH. Call customer service and web support at 800-607-0546 between 8 a. For Benefits & Eligibility questions, check Availity first. Calls may or may not be answered inside the United States. Footer Skip PROVIDER RESOURCE: Quick Contact List Blue Cross and Blue Shield of New Mexico, a Division of Health Care Service Corporation, a Mutual Legal Reserve Company, an Independent Licensee of the Blue Cross and Blue Shield Association 481366. Contact us at 1-877-774-8592 (TTY 711). If you are a BCBSNM member, log in to Blue Access for Members SM (BAM SM) to check your drug list and learn more about your prescription December 30, 2021. Email our Provider Education Consultants. Cost estimates. in the BCBSNM preferred provider (PPO) network HMO-participating provider network and participating pharmacies. 20, 2020; Pharmacy — view Medicare newsletters, drug lists and forms. If you are unable to access this link, please contact your Availity Administrator. medicare. – 7 p. The BCBSNM App helps you find a doctor, hospital or urgent care facility. 2024 QHP Small Group Actual Blue Cross Blue Shield of New Mexico is committed to giving health care providers the support and assistance they need. 888-349-3706 Blue Cross Blue Shield of New Mexico Medical Care Management P. BCBSNM members should call us at the customer service numbers listed on their member ID cards for service. Find the Individual Vision Plans and Family Vision Plans in your area. If you can’t find the information you need, you’ll get a Fast Path phone number that moves you to the top of the calls received list. The Provider Enrollment form opens. BCBSNM Provider Website; Provider Reference Manual; Specialized Trainings; Blue Review Provider Newsletter; Providers may utilize the ProView database at no cost. Call 1-800-MEDICARE (1-800-633-4227) 24 hours a day, 7 days a week. Refer to the Blue Cross Medicare Advantage SM section of the BCBSNM Provider Reference Manual for more information about prior authorization requirements for Medicare members. Blue Access Internet Help Desk If you need help getting into our secure website, Blue Access for Members SM , call the Help Desk toll-free at Before you can join the BCBSNM provider networks, you will need to be assigned a provider record. View frequently asked questions (FAQs) about Availity, the new online service/Web portal for BCBSOK health care providers Provider Customer Service Numbers. Rev 12/2021 P. Network Eligible Providers CAQH Contact Information Help Desk : 888-599-1771: Online Application System URL: HTTPS://PROVIEW. This tool permits registered Availity users to readily view, download, save and/or print the Provider Claim Summary (PCS) online, and other reports as they become available. GuidingCare is accessible to existing Availity administrators : processing delays may occur if rendering provider does not have appropriate documentation of medical necessity. If you have any questions, please contact your provider network representative. BCBSNM Provider Website; Provider Reference Manual; Specialized Trainings; Blue Review Your health plan or network is shown on the front of your Blue Cross and Blue Shield of New Mexico (BCBSNM) member ID card. Find a Doctor. If you are interested in contracting with BCBSNM please contact us at 505-837-8800 or 1-800-567-8540. com Specialty Pharmacy Program Please continue to contact BCBSNM for all New Mexico Medicaid preauthorization requests. Get a free instant rate quote and apply online today for New Mexico health insurance plans including individual and family health insurance, Medicare supplement, short term health insurance and health savings account (HSA) compatible plans at www. if you don’t have online access through a vendor, you may call the below customer service phone number to check claim status or make an adjustment: Medicaid claims – call 800-693-0663; Availity provides Refer to the Blue Cross Medicare Advantage SM section of the BCBSNM Provider Reference Manual for more information about prior authorization requirements for Medicare members. If your health care provider does not send the claim for you, you can file BCBSNM members should call us at the customer service numbers listed on their member ID cards for service. gov Contact Us. Web www. It also provides links to the listings of preferred providers in other states. 3 Internet/Wi-Fi connection is needed for computer access. Blue Cross and Blue Shield of New Mexico, a Division of Health Care Service Corporation, Network Services Department Contact List Author: BCBSNM Created Date: Blue Cross Blue Shield of New Mexico is committed to giving health care providers the support and assistance they need. Printable format for BCBSTX Medicaid Contact List for Provider. If you have questions about which network you have, call the Customer Service number on the back of your card. 2023 Provider Claim Summary is an online application in Availity® Essentials that allows providers to view, download, save and/or print the Provider Claim Summary (PCS) online for finalized claims processed by Blue Cross and Blue Shield of New Mexico (BCBSNM). The BCBSNM contract requires providers to initially submit accurate, complete claims within 180 days of the date of service; see contract page 4, Article II. Altruista Health’s GuidingCare TM Portal via Availity ® Provider Portal. Providers are expected to make treatment decisions based on their medical judgment. ORG : Help Desk Email Address: providerhelp@proview. 1. Customer Service. For help with these documents, please call 1-877-774-8592. This is an important partnership between providers, members, and BCBSNM. To get started, here are some questions to ask a potential doctor: Contact Us. 2024 QHP Small Group Actual For more information, please contact your Provider Network Representative. Choose my contact preferences Providers in Your Network. Contact us if you have questions about electronic transactions that cannot be answered by your clearinghouse or software vendor. If you need help, we’ve created these helpful Provider Network Representative New Mexico 87125-7630 •1-800-567-8540 • www. The BCBSNM online refund management tool will help simplify overpayment reconciliation and related processes. - Fri. Contact Name Phone / Fax / Email / URL Availity ® Essentials Client Services Obtain eligibility, benefits, authorizations, claim status, 2019 Commercial and Medicare Plans Provider Training. Explore our new Claims and Eligibility page for everything you need to know about claims. Prime Therapeutics is responsible for: Processing and paying Rx claims Go digital with your communication preferences. If you are a Turquoise Care member and have questions about your plan, call 1-866-689-1523. Network Services Contacts Blue Cross and Blue Shield of New Mexico (BCBSNM) has been in our community for 84 years. This will be sent regarding: Provider Service Unit Inquiry. For government programs claims, if you don’t have online access through a vendor, you may call the below customer service phone number to check claim status or make an adjustment: Blue Cross Community Centennial claims – call 800-693-0663; Medicare Advantage claims – call 877-774-8592 ; Questions. , MST, 7 days a week. Click the icon to expand the . Dental providers should log in to their secured portal to contact someone for questions about care, payment and claims. ; Provider Finder ® — search for doctors, hospitals, and other health care providers in the Blue To access the form from the Blue Cross Blue Shield of New Mexico website, click the . Ambulance. This training will cover any changes related to Turquoise Care for the topics below. Always go to your Primary Care Provider (PCP) first. Email our Provider Education These tools and services can help you use your Blue Cross and Blue Shield of New Mexico (BCBSNM) membership. 0718_NM_Medicaid_Contact List for Providers_Provider_Card. For more details, see the billing procedures and reimbursement information, Supplement #19-02, previously issued by the New Mexico Human Services Department. Provider Network Representative Related Service Areas . P1721 Rev 12. For group-level assistance, producer can email us. Optum Medical Management Phone number: 505-232-1600; Toll Free: 855-793-9360; Provider Enrollment. Explore Plans We're here to offer you the best plan possible for your family, your business, your health and your lifestyle. This change supports an improved provider onboarding experience with BCBSNM. If you need registration assistance, contact Availity Client Services at 800-282-4548 BCBSNM has contracts with providers across New Mexico and along its borders in Texas, Arizona and Colorado. Enter any additional addresses and contact information For more information regarding the Care Coordination program and the role of the provider, please contact BCBSNM Network Services at 505-837-8800 or 1- 800-567-8540. Claims and clinical appeals address: PO Box 21702 Eagan, MN 55121. This guide will help providers complete the CMS-1500 form: Provider Request for Appeal on Behalf of a Medicaid Member: Request for an appeal on behalf of a Medicaid member: Provider Self-Identified Overpayment Form: Use this form to self-report overpayments identified by the provider: Provider Form for Transportation Attendant Follow the steps below to help find a provider or medical facility that meets your needs. Dental providers who can't able to access their account can read the Dental Summary Guide (PDF) to learn how to: Out-of-network Note: If you see Medicare members or accept Medicare assignment and are willing to bill BCBSNM, you may treat Blue Cross Group Medicare Advantage Open Access (PPO) members. , CT, Monday through Blue Cross Medicare Advantage section of the Blues Provider Reference Manual. Provider Inquiry is for registered, nonregistered and out-of-state providers. If you provide a phone number, an agent may call you to make sure that you received the information Blue Cross and Blue Shield of New Mexico has what you need to successfully sell to and service your clients: Quality health care plans and networks across group, Medicare, and individual markets Blue Cross and Blue Shield of New Mexico, a Division of Health Care Service Corporation, a Mutual Legal Reserve Company, an Independent Licensee of the Blue Cross and Blue Shield Association The Provider Claim Summary application is available in the BCBSNM branded Payer Spaces section on the Availity ® Essentials Provider portal. To reach the right team,please select from below. Doctor reviews and ratings. Insurance Contact Us. Blue Cross and Blue Shield of New Mexico (BCBSNM) has a network of doctors, specialists and hospitals. Find providers numbers for claims, correspondence, managed care and traditional products and more Contact audience. Online: through the Carelon opportunities that improves patient care and the member’s experience with their health plan and their respective providers. Log in to Blue Access for Members SM (BAM SM) Log in to your account to access your health plan information: Find an in-network doctor, hospital or other provider; Pay your bill; Review benefits, account balances, claims Resources for healthcare providers, including provider self-service, news and updates, and tools and resources. When seeking health care services, our members often rely upon the information in our online Provider Finder ®. Explore Plans. By Phone: Call the number on the back of the member’s ID card or dial 800-676-BLUE (2583) to speak to a Provider Service representative. Blue Cross and Blue Shield of New Mexico, a Division of Health Care Service Corporation, a Mutual Legal Reserve Company, an Independent Licensee of the Blue Cross and This allows you to access self-service tools or connect to a chat advocate for support. Check your cellular data or internet service provider’s plan for details. to 6 p. a. Claims/Customer Service. Clinic/facility name: g. Participating with BCBSNM. If you have any problems with your payment, please contact BCBSNM customer service at 800-538-8833. m. Log in to Blue Access for Members SM (BAM SM) Log in to your account to access your health plan information: Find an in-network doctor, hospital or other provider; Pay your bill; Review benefits, account balances, claims status and more These tools and services can help you use your Blue Cross and Blue Shield of New Mexico (BCBSNM) membership. CST, M–F. to noon, CT on weekends and holidays) Electronic Commerce Services. Verification of eligibility and/or benefit information is not a guarantee of payment. Mailing Address for Express Mailing Services only (UPS, FedEx, etc. Provider Resources. From the Centennial Care MCOs, Blue Cross Blue Shield of New Mexico (BCBSNM) and Presbyterian Health Plan (PHP) will continue to provide services after June 30, 2024. 2 The 24/7 Bilingual Nurseline may not be available with all plans. Blue Cross and Blue Shield of New Mexico P. e. We'll help you find new providers or check and see if your current providers are in our network. S. Members should call the number on the back of their BCBSNM member ID card. We would like to show you a description here but the site won’t allow us. See section 14. Box 660738 Dallas, TX 75266-0738. Provider Information Toolkit Marketing Campaigns 16 Your Partners in Health & Practice 03 Provider Marketing Materials 21 Educational Videos 26 Dual Eligible The online directory tool allows you to easily download, print and/or share the health care provider information via email. 1-800-325-8334. We also will mail you a printed copy of your plan’s provider directory, if preferred. Carelon Contact Center – 866-455-8415 (Monday through Friday, 6 a. Contact Information for Blue Cross and Blue Shield of New Mexico. New Mexico Help Center: Important contact information for Blue Cross and Blue Shield of New Mexico. It’s helpful if you have your provider number or NPI and, if applicable, the member’s ID number, account number and claim number handy when you call. ) If you are interested in contracting with BCBSNM please contact us at 505-837-8800 or 1-800-567-8540. Care management. Log in to Blue Access for Members SM (BAM SM) Log in to your account to access your health plan information: Find an in-network doctor, hospital or other provider; Pay your bill; Review benefits, account balances, claims status and more Click on the link to access Provider Finder. There are two ways to download the free BCBS NM App: Text BCBS NM APP to 33633; Go to the iTunes App Store or Google Play store and download the BCBS NM App. Learn about our Medicaid plan Electronic: BCBSNM contracted providers can submit electronic preauthorization requests for out-of-area Blue Plan members through Availity or your preferred web vendor. Verify Customer service. Monday – Friday: 7 a. Claims will be processed out-of-network, until the provider has applied for network participation, been approved and Blue Cross and Blue Shield of New Mexico, a Division of Health Care Service Corporation, a Mutual Legal Reserve Company, an Independent Licensee of the Blue Cross and Blue Shield Association Contact Phone/Fax/Internet Member/Provider Customer Service (excluding Blue Cross Medicare Advantage Dual Care (HMO D SNP) (To obtain benefits, eligibility or claims status) 1-877-774-8592; Hours of operation: 8 a. When you get in-network care, you may have lower costs. Provider Reference Manual (Printable PDF) Effective: 01/01/2024. Under 65 Email Us. These providers are contracted with BCBSNM to provide medical services to members. Be sure to include your name, direct contact information, tax ID or billing NPI. Phone (800) 693-0663 Email BCBSNM_Medicaid_Provider_Customer_Service@bcbsnm. Fax Numbers: Case Management 505-816-3861; Disease Management Note: A BCBSNM provider record does not automatically activate the NM network. Find a Doctor or Hospital; Find a Dentist; Find a Pharmacy; Find a Vision Provider; Look at the back of your BCBSNM member ID card. BCBSNM Provider Education Consultants. Contact Us; Language Assistance; Policy Documents. Ordering provider may need to initiate prior authorization. This information is ONLY applicable to Federal Employee Program ® (FEP ®) and Blue Cross Community Centennial SM Contact us for health care providers Contact us for healthcare providers. Be sure to include your name, direct contact information & Tax ID and/or billing NPI. and 6 p. Note: If you do not have Availity access, you may continue to submit your requests using the Claim Appeal form located on our provider website. Our general phone number is: 803-788-0222. P1631 Rev 5/17. Out-of-state providers notification: You should specifically contact your local Blue Cross and Blue Shield (BCBS) Plan for 835 ERA enrollment. caqh. Improve operational efficiency and turnaround time on claims by using electronic transactions for billing, payments, eligibility, and claim status. For general inquiries and questions about the Service Benefit Plan, our overseas and pharmacy coverage or fraud assistance, you can call us toll-free nationwide. 1, 2024, BCBSNM is implementing parallel credentialing and contracting processes. Medicare Advantage and Community Plan 800-600-9007. Physicians must complete and submit a request form for all PA and ST medications. Availity’s Claim Submission tool allows providers to quickly submit electronic Professional (ANSI 837P) and facility, or Institutional (ANSI 837I) claims or encounters to Blue Cross and Blue Shield of New Mexico (BCBSNM), at no cost. If an existing enrollment is already on file with the local BCBS Plan, then ERA files for services provided to BCBSNM members will be transmitted electronically to you under the Blue Cross Blue Shield . Message and data rates may apply. at no charge. Eligibility, Benefits, Provider Network Referral, Claim Status: STAR, CHIP: 1-877-560-8055 STAR Kids: 1-877-784-6802 8:00 a. The Reporting On-Demand application is available in the BCBSNM branded Payer Spaces section on the Availity ® Provider portal . contact the IHS Service Unit for a new PDO. Choosing to get your BCBSNM communication by email or text can help you better keep track of important information about your health plan. Visit the Plan Documents page to see documents about your Blue Cross Medicare Advantage plan, like the Evidence of Coverage (EOC) and Annual Notice of Find a doctor or hospital in New Mexico quickly and easily using the Blue Cross Blue Shield of New Mexico Provider Finder. Contact Name Phone/E-mail/URL; Provider Service Unit. Like health plans, vision insurance plans use certain groups of doctors, hospitals and other health care professionals called provider networks. Have questions about your benefits or a claim? If you have questions about any information in your Blue Access for Members account, you can: Before you can join the BCBSNM provider networks, you will need to be assigned a provider record. Out-of-network providers will be paid the Medicare-allowed amount less any member cost-sharing. Administrative contact: d. Find a doctor or hospital in New Mexico quickly and easily using the Blue Cross Blue Shield of New Mexico Provider Finder. Don’t have an account? Provider Finder ®. For all Medicare Advantage claim questions, excluding claims previously filed with Lovelace, for dates of service prior to and after June 1, 2014, contact BCBSNM Customer Service at 877-895-6448. Enter Contact Phone Number Select Add Files (maximum of 10) Select Submit Request, receive confirmationand view details Claim# 123456789012X01. BCBSNM utilizes CAHPS Provider Network Representative Related Service Areas 5701 Balloon Fiesta Parkway • Albuquerque, New Mexico 87113 • 1-800-567-8540 • www. Box 27630 • Albuquerque, New Mexico 87125-7630 •1-800-567-8540 • www. contact. The Centers for Medicare & Medicaid Services (CMS) requires all Special Needs Plans (SNPs) to provide an annual training on the Model of Care (MOC) for all providers who provide services to SNP members. For more information about submitting claims, refer to Section 8 , Claims Submission in our Provider Reference The BCBSNM contract requires providers to initially submit accurate, complete claims within 180 days of the date of service; see contract page 4 Blue Cross Blue Shield of New Mexico - Health Insurance New Mexico. MT Vision Provider Networks. Maintenance Notification: Blue Access for Members and quoting tools will be unavailable from 3am - 6am on Saturday, October 20. We're here to help (651) 662-5200 1-800-262-0820 (toll free) (651) 662-2745 (fax) Mon. To obtain benefits, eligibility, or adjust a claim. Electronic: BCBSNM contracted providers can submit electronic prior authorization requests for out-of-area Blue Plan members through Availity or your preferred web vendor. PLEASE USE CHROME BROWSER TO COMPLETE FORM. Except in an emergency, this plan does not cover care received from out-of-network providers. Not near one? The following table includes some common reasons providers contact us and options for each. Forgot user name or password. You may also contact BCBSNM Health Care Management at 505291-3585 or 1800- -325-8334. Group Health Insurance Plans Built for Business. The BCBSNM Medicaid plan focuses on breaking down the financial, cultural, and linguistic barriers preventing low-income families and individuals from If you have any questions, please contact the BCBSNM Health Services Department at 800-325-8334. If you have any questions, please contact the BCBSNM Health Services Department at 800-325-8334. Altruista Health GuidingCare is a web-based care management tool for assigned providers to monitor rendered services, activities, quality measures and care plans for Blue Cross Community Centennial SM members. Blue Cross and Blue Shield of New Mexico (BCBSNM) has been in our community for 84 years. B. Use this form if you are changing your group/practice contact information. Fax: 1-713-663-1227 Email to submit provider inquiries: Ambulatory 1 Prior Authorization not required in certain circumstances, such as emergency or urgent situations. How to Join the BCBSNM Provider Networks. Even if you’re not a member, you can search for doctors, hospitals and other providers. Attach supporting documentation if necessary. The MCO you have now will provide services through June 30, 2024. Annual Provider Training. You may also contact BCBSNM Health Care Management at 505-291-3585 or 1-800-325- 8334. www. Your employees are your most valuable assets. As one of the largest providers of health benefits in New Mexico, we are pleased to offer this plan for those New Mexicans who qualify. Related Resources: Eligibility and Benefits Tip Sheets; Medical Policies; Verification of eligibility and/or benefit information is Providers – Please Verify Your Information Every 90-Days and Update Your Information, As Appropriate. Provider type/specialty: c. Submit completed forms to: BCBSTX Behavioral Health Unit and if applicable, Medicare Numbers for your provider when contacting Ancillary Network Management. Data charges may apply. Update Your Provider Information. (The code will be sent to the email or mobile phone number tied to your account. indd This page may have documents that can’t be read by screen reader software. 1-800-626-2212 - Behavioral Health Provider Services If you have questions related to your application for participation with BCBSNM provider networks, you should contact your local Professional Provider Network office for assistance. This link will take you to a new site not affiliated with BCBSNM. Benefits will apply if the member meets specified criteria. Note: A BCBSNM provider record does not automatically activate the NM network. New Application: • To submit a new application, choose New Application radio button. Highlights of how our work makes an impact for our members, customers, employees and If you are a member with a question about your coverage, please contact Customer Service or a specific department listed on this page: Individual and Family Plan. Once you qualify, you can pick a health plan. Please Select Your State The resources on this page are specific to your state. Phone: Many dental services are covered when you see an in-network provider: Preventive dental care – oral exams, cleanings, x-rays, topical application of fluoride, sealants Restorative dental care – fillings and prefabricated resin crowns 2019 Commercial and Medicare Plans Provider Training. Based on your location, you may be able to get in-network care at: Contact Us. Box 27630 Albuquerque, NM 87125-7630 1-505-291-3500 1-800-835-8699. GuidingCare is accessible to existing Availity administrators Print Reporting On-Demand. NOTE: if this is a request for second review, you must provide information not previously submitted for review to be eligible. O. HOME LEGAL AND PRIVACY NON-DISCRIMINATION NOTICE CONTACT US 1-800-567-8540. ) Most often, your health care provider will submit a claim on your behalf. com. For more information, please contact your Provider Network Representative. Group Membership and Eligibility Inquiries 1-855-346-2015 These tools and services can help you use your Blue Cross and Blue Shield of New Mexico (BCBSNM) membership. PROVIDER RESOURCE: Quick Contact List Blue Cross and Blue Shield of New Mexico, a Division of Health Care Service Corporation, a Mutual Legal Reserve Company, an Independent Licensee of the Blue Cross and Blue Shield Association 481366. Tips for HMO Health Plan Members. For vaccinations covered under the prescription drug benefit, select vaccines can be conveniently administered at a participating vaccine network pharmacy near you. com . ) 5701 Balloon Fiesta Parkway NE Albuquerque, NM 87113. Via Phone: (800) 859-5299. BCBSNM's Medicaid plan can help you meet your health care needs. Box 27630 Albuquerque, NM 87125-7630 505-291-3500 800-835-8699. For other important phone numbers, contact us. , CT; and 9 a. NE Albuquerque, NM 87107 BCBS Federal Phone Number - FEP List Statewise Customer Service Precertification Mental Health/Substance Abuse Case Management Hospital; Alabama (800) 248-2342 If you are interested in contracting with BCBSNM please contact us at 505-837-8800 or 1-800-567-8540. NPI #: e. Are You a Provider? Contact Customer Service at 1-800-245-1609. ; Blue Cross Medicare Advantage section of the Blues Provider Reference Manual effective Feb. call BCBSNM at 1-866-445-1396 or contact your independent, authorized broker. Start with a search. Registering as a Managed Care Provider; Onboarding and Credentialing; Disclosure of Ownership and Control Interest Form; Provider Resources. To contact Accredo, call 1-833-721-1619, Integrated coordination of coverage between the member, provider and BCBSNM; No up-front acquisition cost to providers for office-administered specialty medications; Convenient delivery of medication to location of choice (i. Explore tools designed to help health care providers conduct research and simplify billing. GuidingCare is accessible to existing Availity * BCBSNM has contracted with a third-party vendor, Alacriti Payments, LLC, to process your ACH/electronic check payment. If you are hearing or speech impaired, call 1-877-486-2048. 0718 2049551_481366. Providers. Medicaid. Telephone: Call BlueCard Eligibility at 800-676-BLUE (2583) Rev 03/24/14 A Division of Health Care Service Corporation, a Mutual Legal Reserve Company, an Independent Licensee of the Blue Cross and Blue Shield Association. Contact Us. We also have South Carolina BLUE retail centers in Columbia, Greenville and Mount Pleasant where you can speak to us in person. 7 a. - 8 p. 1 Internet/Wi-Fi connection is needed for computer access. Contact Information Call Center 601-932-1122 or 1-800-257-5825 EDI Services 601-664-4357 or 1-800-826-4068 State and School Employees' Health Plan For provider information on members of the State and School Employees' Health Plan please use the following numbers: Benefits, Eligibility and Claims Status 1-800-709-0973 Pre Providers; Company Information; Language Assistance; En español Your BCBSNM plan has tools and benefits that can help you achieve — and spend less on — health and wellness in 2024. Search for a doctor by name, location or specialty to find a doctor in your area to meet your health care needs. Carelon Contact Information. 1 – CONTACT LIST FOR IN-NETWORK PROVIDERS . Provider’s EIN and billing address on the claim must be an exact match to the PDO. Provider Contacts Physician Services 1-800-624-1110 - Physical Health Provider Services. Contact lenses, and more; Review Plans and Pricing. 6 of the Blues Provider Reference Manual for a description of the Specialty Pharmacy Program, preauthorization requirements, split fill program, and additional specialty services. Sign Up or Log In. Insurance Basics. Health Care Costs; Types of Welcome to the Blue Cross Blue Shield of New Mexico Provider Services Line. Please contact your regional representative to reach the contract management team. 3. Non-emergency medical service in Idaho, Montana and New Mexico is limited to interactive audio/video (video only), along with the ability to prescribe. BCBS Provider Phone Number; Alabama: 800-517-6425 (Benefits/Eligibility) 800-327-3994 (PEEHIP) 800-760-6851 (Customer Service) 800-492-8872 (Federal Employee Program) 800-668-3813 (Healthspring) Alaska: 800-722-4714 (Claims, Benefits/eligibility) Premera Blue Card Provider Phone Number: 888-261-9562 The online directory tool allows you to easily download, print and/or share the health care provider information via email. GuidingCare is accessible to existing Availity administrators If you are a member with a question about claims or your coverage, please contact a Customer Advocate by calling the number on the back of your member ID card. with BCBSNM for the Blue Cross Community Centennial plan network, you must receive prior authorization from BCBSNM The list is current as of the date it was published Our printed provider directory is updated monthly If at any time you need a copy, please contact Member Services BCBSNM will send a provider directory within ten days of Blue Cross Blue Shield of New Mexico is committed to giving health care providers the support and assistance they need. Contact the doctors or hospitals on your list and ask for more information that's important to your decision. bcbsnm. 1-1 . Providers may submit the NM Uniform Prior Authorization form electronically through CoverMyMeds Email our Provider Education Consultants. You must use in-network providers. Claims will be processed out-of-network, until the provider has applied for network participation, been approved and Curious about Blue Cross Blue Shield of New Mexico health plans? Find FAQs for benefits and services. DEA # if applicable: f. In-network providers will be paid at their contracted rate. 3. Learn More. Precertification. To identify your Availity Electronic: BCBSNM contracted providers can submit electronic prior authorization requests for out-of-area Blue Plan members through Availity or your preferred web vendor. As of Jan. tab. Find a Doctor or Hospital; Find a Dentist; Find a Pharmacy; Find a Vision Provider; Virtual Visit; Providers Outside of U. Clinic/pharmacy/facility street Contact Us. Telephone: Call BlueCard Eligibility at 800-676-BLUE (2583) Please continue to contact BCBSNM for all New Mexico Medicaid preauthorization requests. Find resources for Blue Cross NC Providers in- and out-of-network to manage patient claims and appeals, eligibility, prior authorization and more. . Molina Health Care of New Mexico (MHC) and United Health Care (UHC) will be available as new MCOs providing Global Core helps BCBSNM members find health care providers in more than 200 countries around the world. availity. , Monday through Friday, Pacific Time. We're here to help answer your questions. Learn how to contact your local Blue Cross and Blue Shield company, as well as other key areas. A provider’s reimbursement is based on a combination of the services covered under the member’s benefit plan in conjunction with a provider’s contract(s) with Blue Cross and Blue Shield of New Mexico (BCBSNM). 2024 QHP Small Blue Cross and Blue Shield of New Mexico (BCBSNM) has been in our community for 84 years. Offered through Coverage Plus Central 1. Fax Numbers: Case Management 505-816-3861; Disease Management These providers are contracted with BCBSNM to provide medical services to members. If you do not qualify for Medicaid, you may be able to get an Individual and Family health plan with BCBSNM at little or no cost. BCBSNM Provider Customer Service Claims, benefits, etc. Fax Numbers: Case Management 505-816-3861; Disease Management Altruista Health’s GuidingCare TM Portal via Availity ® Provider Portal. Blue Cross Blue Shield of New Mexico is committed to giving health care providers the support and assistance they need. , provider’s office, site of practice, home infusion) Availity Fee Schedule tool allows professional providers participating with BCBSNM to electronically request a range of up to 20 procedure codes and immediately receive the contracted price allowance for the patient services you perform. Attachments: Blue Card Program Provider Manual Medicare Advantage Attachment Blue Cross Community Centennial Attachment; Turquoise Care Print Altruista Health’s GuidingCare TM Portal via Availity ® Provider Portal. Group Membership and Eligibility Inquiries 1-855-346-2015 We offer two ways to find patient eligibility information — by logging into our secured provider portal or by calling Provider Inquiry, an automated response system. com A Division of Health Care Service Corporation, a Mutual Legal Reserve Company, an Independent Licensee of the Blue Cross and Blue Shield Association . Network Adequacy Exception Process. More. 2) If you are a registered BAM user, you can enroll by logging into your BAM account, going to the Preferences page and entering your FEP plan questions for dates of service prior to and after June 1, 2014, contact the BCBSNM Provider Service Unit at 888-349-3706. Services Provided in a Licensed Birth Center Blue Cross Blue Shield of New Mexico - Health Insurance New Mexico. Failure to maintain credentialing status can result in provider termination from all networks. Whatever the size of your business, health plans from Blue Cross and Blue Shield of New Mexico (BCBSNM) can help you create a healthier and more productive workplace that attracts and retains top talent. Who do I contact for administrative support if I have questions when utilizing the database? The CAQH Help Desk provides telephone service Monday through Altruista Health’s GuidingCare TM Portal via Availity ® Provider Portal. 1, 2022, the federal Consolidated Appropriations Act (CAA) of 2021 requires that certain provider directory 1) You can provide your mobile phone number when you apply for coverage. For more information regarding the Care Coordination program and the role of the provider, please contact BCBSNM Network Services at 505-837-8800 or 1-800-567-8540. Providers in Your Network. com Registration Required Call 1-800-528-7264 or the phone number listed on the back of the member's/subscriber's ID card. O. Specialty Pharmacy Program Along with the phone options above, you can also visit the Blue Cross Medicare Advantage Member Services page to find drug tiers and search for in-network providers. Provider name: b. 11 Provider Re-Credentialing • The process of re-credentialing is similar to the initial Contact your local Blue Cross and Blue Shield company Find My Plan. From February 15 through September 30 alternate technologies This form must be completed by the member and/or provider for any Blue Cross and Blue Shield of New Mexico (BCBSNM) member receiving ongoing behavioral health care with an out-of-network provider. Related Resources: Behavioral Health Clinical Practice Guidelines; Horizon Blue Cross Blue Shield Providers numbers & addresses. It will open in a new window. Or, you can call the phone number listed on your member ID card. You’ll see details that may help you lower health care costs. Telephone: Call BlueCard Eligibility at 800-676-BLUE (2583) Carelon Provider Portal. Providers may submit coverage exception requests by fax to 1-877-243-6930, by phone at 1-800-285-9426 (TTY/TDD 711), or electronically on MyPrime. If an original claim is submitted after the 180-day limit, it is denied for timely filing. to 5:00 p. Street Address - FSU/Customer Service 4373 Alexander Blvd. We will now start the credentialing process (subject to complete CAQH credentialing application) at the same time the contract is sent to the provider to sign. section and click the hyperlink to the Provider Onboarding Form. Blue Cross and Blue Shield of New Mexico (BCBSNM) utilizes Prime Therapeutics LLC as our pharmacy benefit manager to administer our pharmacy program to help contain rising drug costs and maintain and improve the quality of care delivered to members. A Division of Health Care Service Corporation, a Mutual Legal Reserve Company, an You can contact Medicare for more information about Medicare benefits and services, including general information about Medicare Advantage Prescription Drug coverage. 2019 Commercial and Medicare Plans Provider Training. Availity 800-282-4548. 23. What’s Changing: Blue Cross and Blue Shield of New Mexico (BCBSNM) is changing prior authorization requirements that may apply for some commercial and Medicaid Blue Cross Community Centennial SM members to reflect new, replaced or removed codes due to updates from Utilization Management or the – BCBSNM will contact the provider to schedule and conduct site visits. ) Medicaid behavioral health services are managed by BCBSNM for all members who have Medicaid medical benefits. Log in to your account to get the most accurate, personalized search results based on your plan. If you choose to see a doctor who is not part of our network, you will have to pay for the services. Contact Us Newsroom Blue Cross and Blue Shield of New Mexico, a Division of Health Care Service Corporation, a Mutual Legal Reserve Company, an Independent Licensee of the Blue Cross and Blue Shield Association Provider Information Toolkit Marketing Campaigns 16 Your Partners in Health & Practice 03 Provider Marketing Materials 21 Educational Videos 26 Dual Eligible Express Scripts ® Pharmacy, the mail order pharmacy for members with BCBSNM prescription drug coverage, provides safe, fast and cost-effective pharmacy services that can save you time and money. Dental Customer Service 1-800-367-6401 If you have any questions, please contact the BCBSNM Health Services Department at 800-325-8334. With this program, you can obtain up to a 90-day supply of long-term (or maintenance) medications through Express Scripts ® Pharmacy. indd Blue Cross Blue Shield of New Mexico is committed to giving health care providers the support and assistance they need. If you need registration assistance, contact Availity Client Services at 800-282-4548. Log in to Blue Access for Members SM (BAM SM) Log in to your account to access your health plan information: Find an in-network doctor, hospital or other provider; Pay your bill; Review benefits, account balances, claims status and more Provider Name: NPI: Contact Person: Phone Number: *Provide detailed information about your review request, including additional claim numbers, if applicable. Prescription Inquiries 1-800-423-1973. Agenda. 1-800-245-1609 . BCBSNM vision plans have large provider networks. 4. com or CoverMyMeds ® website Providers can find forms on MyPrime. org: Help Desk Hours: 6 a. kqy xmaryj nbtn rxkyp tjszfxdy fldx eutdn jvnbsxj hgt mtrtz