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This section identifies the policies and procedures for dispute resolution that providers have a contractual obligation to follow. Here is a list of operational issues that may be identified as areas of concern for providers participating with BCBSNM:

• Disputes regarding claims
• Determination of medical necessity
• Contract issues, including contractual language, reimbursement, termination, and credentialing/quality issues
• Quality of care issues
• Potential cases of fraud

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Non-participating providers may refer to information about the No Surprises Act.

In a continuing effort to reduce administrative costs and improve claim turnaround, BCBSNM requires complete CMS-1500 information on all claims, including National Provider Identifier. Incomplete claim forms will be returned to you for required information. Más información

• Atrial Fibrillation Documentation & Coding Guideline 
• Diabetes Mellitus Documentation & Coding Guideline 
• Major Depressive Disorder Documentation & Coding Guideline 

BCBSNM strongly encourages the electronic submission of claims. Claims may be submitted electronically 24 hours a day, seven days a week. All BCBSNM facility (UB04) and professional (CMS-1500) claims (excluding adjustments) can be filed electronically at no charge through the Availity^® Health Information Network.

The electronic payer ID for BCBSNM is 00790 and is recognized by most clearinghouses in order to route electronic claims to BCBSNM. All electronic claims submitted to BCBSNM must be routed with payer ID 00790. You may need to contact your clearinghouse if they use a different BCBSNM payer ID.

For more information about submitting claims, refer to Section 8, Claims Submission in our Provider Reference Manual. For any Electronic Funds Transfer (EFT) and Electronic Remittance Advice (ERA) questions refer to the EFT/ERA section.

NDC Billing Guidelines 

NDC Frequently Asked Questions 

Taxonomy codes are administrative codes set for identifying the provider type and area of specialization for health care providers. Each taxonomy code is a unique ten character alphanumeric code that enables providers to identify their specialty at the claim level. Taxonomy codes are assigned at both the individual provider and organizational provider level. Más información 

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.B.3. If an original claim is submitted after the 180-day limit, it is denied for timely filing.

Refer to Section 8 of the Blues Provider Reference Manual to find out more about submitting claims, acceptable proof of timely filing and more. Más información

Upon a recent review of claim denials, we have identified the most common issues that can cause delays in claims processing. These are a few tips to keep in mind when filing claims. Más información

The Uniform Bill (UB-04) is the standardized billing form for institutional services. This is a guide to help with completion of the UB-04 form for your patients with Blue Cross (facility) coverage. Más información