At Blue Cross and Blue Shield of New Mexico (BCBSNM), we are committed to providing support to physician practices. We've designed tools that health care providers find useful. Whether doing research or streamlining billing, these tools can help you evaluate costs, save time, improve service and more.
Availity® Essentials
Availity offers a secure Internet portal for providers to interact with the payers in the Availity network. Availity offers a variety of tools to providers that are listed below.
Altruista Health’s GuidingCareTM Portal via Availity® Provider Portal
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 CentennialSM members. GuidingCare is accessible to existing Availity administrators and assigned users in the BCBSNM-branded Payer Spaces section in the Availity Portal. Más información
Availity® Authorizations
Authorizations is an online tool in Availity Essentials that allows you to submit prior authorization requests handled by BCBSNM. Más información
Availity® Attachments: Submit Recommended Clinical Review Requests
Attachments is an online tool in the Availity Essentials portal that allows you to submit electronic recommended clinical review (formerly predetermination of benefits) requests handled by BCBSNM. Más información
Availity Eligibility and Benefits
It is important to verify membership and check coverage details for every patient at every visit before you administer treatment.
To obtain fast, efficient, detailed benefits information for BCBSNM members, you can use Availity's Eligibility and Benefits tool. This free online tool can provide you with co-payment, co-insurance, deductible, and other important information.
For additional details, refer to the Availity Eligibility and Benefits User Guide
BlueApprovRSM
BlueApprovR is an online tool accessible in Availity® Essentials that allows providers to submit inpatient and/or outpatient prior authorization requests for medical/surgical, specialty pharmacy drugs, and behavioral health services, as well as recommended clinical review (RCR) requests for medical/surgical and specialty pharmacy drugs for many BCBSNM commercial members. Más información
Claim Inquiry Resolution – High-Dollar, Pre-Pay Reviews
Claim Inquiry Resolution is available via a tab in our Electronic Refund Management (eRM) system. The CIR function provides a method for inquiry submission related to High-Dollar, Pre-Pay Review requests for most Host (BlueCard® out-of-area) claims (Medical Records and/or Itemized Bills) handled by BCBSNM. Más información
Claim Reconsideration Requests
The Claim Reconsideration tool allows providers to electronically submit claim reconsiderations for situational finalized claim denials (including BlueCard® out-of-area claims), using Availity’s Dispute capability anchored off the enhanced Claim Status tool. Más información
Claim Status Tool
The Availity® Claim Status Tool offers enhanced, real-time claim status functionality to help you manage and resolve claims processed by BCBSNM. Más información
Clear Claim Connection
Clear Claim Connection is a web-based code auditing reference tool that mirrors BCBSNM edits (i.e., unbundling, mutually exclusive, and incidental). Más información
CoverMyMeds®
CoverMyMeds is an online tool for electronic completion and submission of benefit prior authorization (PA) requests for prescription drugs that are part of BCBSNM pharmacy PA program. Más información
DNoA Connect
DNoA Connect is a provider self-service tool where dental offices can conveniently connect to patient information for members with BlueCare DentalSM.
Electronic Claim Submission via Availity® Essentials
Availity’s Claim Submission tool allows providers to quickly submit electronic Professional (ANSI 837P) and facility, or Institutional (ANSI 837I) claims or encounters to BCBSNM, at no cost. Más información
Electronic Clinical Claim Appeal Request via Availity®
The Dispute tool allows providers to electronically submit appeal requests for specific clinical claim denials through the Availity Portal. Más información
Gestión electrónica de reembolsos
Electronic Refund Management is an online tool that can help simplify your overpayment reconciliation and related processes. Más información
Fee Schedules via Availity® (Professional Providers)
The 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. Más información
Interpreter Services
Interpreter services allows providers to arrange interpretative services for limited English Proficient (LEP) individuals and interpretative services for patients who qualify under the Americans with Disabilities Act (ADA). Más información
Manage My Organization via Availity® Essentials
Manage My Organization in the Availity Essentials portal allows administrators and users to add provider(s) within your organization(s) or edit existing ones, for easy data entry when submitting transactions handled by BCBSNM. Más información
Medical Record Status Viewer
The Medical Record Status Viewer is an online application that allows providers to confirm receipt (up to four) of the most recent medical records submitted by mail or fax to BCBSNM for claim processing and prior authorization requests. Más información
Message This Payer Application
The Message This Payer application in Availity® Essentials allows providers to send secure messages to BCBSNM for claim management questions and follow along with the conversation history. Más información
National Drug Code (NDC) Units Calculator Tool via Availity®
The National Drug Code (NDC) Units Calculator is a user-friendly online tool that allows providers to convert applicable classified or specified Healthcare Common Procedure Coding System (HCPCS) or Current Procedural Terminology (CPT®) codes to NDC units. Más información
Patient Care Summary
The Patient Care Summary tool uses claim-based information to provide you with a consolidated view of a patient's health care history at the point of care. Más información
Patient Cost Estimator
The Availity® Patient Cost Estimator tool is an online member liability estimator that can help professional providers estimate a patient's potential out-of-pocket costs in real-time for office and outpatient services provided to BCBSNM members. Más información
Patient ID Finder
The Availity® Patient ID Finder tool allows providers to obtain the BCBSNM patient ID number and group number by entering patient-specific data elements. Más información
Physician Efficiency, Appropriateness, & QualitySM (PEAQSM) Program
The Physician Efficiency, Appropriateness, & Quality (PEAQ) Program evaluates physician performance in a transparent and multidimensional way. Más información
Provider Claim Summary
The Availity® Reporting On-Demand Provider Claim Summary application allows users to readily view, download, save and/or print the Provider Claim Summary (PCS) and other reports online, at no additional cost. Más información
Provider Data Management (PDM)
Provider Data Management (PDM) is a web-based tool in Availity® Essentials that allows professional providers, facility and ancillary to quickly update, validate and attest to the accuracy of their information on file with BCBSNM. Más información
Remittance Viewer
The remittance viewer offers providers and billing services a convenient way to view and help reconcile claim data provided by BCBSNM in the 835 Electronic Remittance Advice (ERA). Más información