BLUE CROSS BLUE SHIELD OF NEW MEXICO has transitioned all clearinghouses to a new electronic
transaction system for eligibility inquiries!
BCBSNM
hopes this new system will result in improved benefit information for their providers, and certain known issues have
been resolved with this implementation, including:
·
Eligibility benefits
for Blue Cross Blue Shield of Texas members is now available
·
BCBSNM
Eligibility responses will no longer show “Member Inactive” when the member’s
group number is inactive and the member issued a different group number from
BCBS
·
Eligibility
Inquiry will accept provider NPI on electronic transactions
IMPORTANT: BCBSNM will return eligibility and benefits
tailored the criteria entered for:
- PROVIDER
- PLACE
OF SERVICE
- SERVICE
TYPE
The new BCBS eligibility inquiry
criteria screen:
PROVIDER:
Effective with this release,
BCBSNM inquiries will now accept your provider NPI. HealthXnet will be transitioning your account
to include NPIs on BCBSNM inquiries following the release of this inquiry. IMPORTANT: BCBSNM will return eligibility and benefits tailored to the BCBSNM
services contracted to the selected Provider ID! Picking an incorrect Provider ID for the Service
Type and Place of Service selected may result in poor or no benefit data
returned on your inquiry. For example,
if the Provider ID selected is not contracted for Licensed Ambulance services,
no detail on Licensed Ambulance benefits will be returned on your inquiry.
PROVIDER ID OPTIONS ARE:
- Type I NPI (Entity) = NPI assigned to an
individual provider
- Type II NPI (Organization) = NPI assigned to a
facility
- BCBSNM Legacy Provider ID = will be phased out
by May 23, 2008
PLACE OF SERVICE:
Effective with this release,
BCBSNM inquiries require that Place of Service be selected on all eligibility
inquiries. IMPORTANT: BCBSNM will return eligibility and benefits tailored to the selected
Place Of Service.
Picking an incorrect PLACE OF SERVICE for the Provider ID and Service
Type selected may result in poor or no benefit data returned on your
inquiry. For example: If the Provider ID
selected is contracted for Hospice services, and you select Service Type =
Hospice and place of service = Outpatient Hospital, no Hospice benefit data
will be returned, because Outpatient Hospital is not a valid Place of Service
for Hospice services.
PLACE OF SERVICE OPTIONS ARE:
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