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Recent News: UPDATED 11.08.2017 Family Practice Internal Medicine/Geriatric Pediatrics Urgent Care/Occupational Specialists Anesthesiology Cardiology Critical Care Dermatology Emergency Medicine Gastroenterology Geriatrics Hospitalists Lab Services / Diagnosic Centers Nephrology Neurology OB/GYN Oncology / Hematology Orthopedics Endoscopy Pain Management Pathology Physical Medicine / Rehab Podiatry Radiation Oncology Radiology Rheumatology Surgical Specialists Otolaryngology Chiropractic Acupuncture Home Health / DME Optometry / Opthhalmology Prosthetics / Orthotic Albuquerque Providers PT / OT / ST

The San Juan IPA was founded in 1986 by a group of 21 community physicians to partner with

insurance companies with the goal of improving the quality of care to patients while simultaneously

decreasing the cost of care to those payers. Originally formed with a “Quality Assurance Committee”,

the San Juan IPA has grown to over 450 members representing 39 specialties and sub-specialties

in 70+ offices across New Mexico, a HEDIS quality review function, a Credentialing Committee,

and a care management committee component.

As an NCQA-accredited organization, San Juan IPA’s core services of contracting and

credentialing are complemented by an array of expanding resources for the physician office,

helping keep practice costs low and quality of care high.  We continually look for ways to

promote new quality initiatives both within and outside the practice walls for patients and employers.

  1. To ensure that a heath care delivery system is in place, which provides available, accessible and adequate numbers of facilities, locations, and personnel for the provision of health care services.
  2. To ensure that a health plan members are provided covered services without regard to race, color, creed, sex, religion, age, national origin, ancestry, marital status, sexual preference or physical or mental handicap.
  3. To ensure that the SJIPA has in place the organizational and administrative systems capable of messaging medical services contracts between providers and third party vendors
  4. To ensure that the quality of care to all patients continues at the highest level of  care possible.  
  5. Provide support for community health education and wellness.

Santa Fe Providers Gallup Providers Wound Care JOIN US! Behavorial Health Employment Opportunities Pay Membership Dues/Invoices Las Cruces Providers More News!


All San Juan IPA Members:  San Juan IPA Notice to Members

To all IPA Members:  It has come to our attention that certain payers are again becoming aggressive in attempting to get our members to sign contracts away from the IPA.  In one instance in an attempt to resolve a breach of contract issue the payer offered to give the member a new contract away from the IPA; that member refused.  In another instance the payer is spreading misinformation regarding the IPA by telling the member that we don’t have a presence in the Albuquerque market.  KNOW YOUR IPA!  San Juan IPA has a large and growing presence across the state of New Mexico, and the payer community doesn’t like it one bit.  Check our website often as we update it often!  New providers, new areas, new specialties are constantly updated and are available on the home page.  Have a question?  CALL US- DON’T BELIEVE EVERYTHING YOU HEAR!  We are here for you, our members.  We’re very sure the payers can’t say the same about you!

SJIPA Round Table Meeting:  Tomorrow November 15, 2017 at 12:00 pm

San Juan IPA will be hosting our second quarterly “Round Table” meeting.  The meetings are for all Members, Office Managers/Administrators and Billers and any other staff you believe may benefit.  Our next round table meeting is Wednesday November 15, 2017 at 12:00 pm in the Suns Room at San Juan College (using the cafeteria or Mary’s Kitchen entrance the room will be to the right).  Please note lunch will be provided and we want to be sure to have plenty of food, please RSVP with Kami Calder (kcalder@sanjuanipa.com) or Heather DeLaBarcena (heatherd@sanjuanipa.com).  Remember, this meeting is for you and your participation is important!

The agenda will focus on:

NPPES/Taxonomy codes

Modifier 25

Medicare Advantage:  Participating vs. Non-participating: you can still get paid!

All Albuquerque, Santa Fe, Las Cruces and Gallup members are welcome to join remotely.  You may access the meeting online by clicking this link at the scheduled time:  https://zoom.us/j/478933513?pwd=bYnZkLtdKmgy9ByswLq2LQ - Meeting ID:  478 933 513   Password:  Sanjuanipa

San Juan Regional Medical Center:  Letter of the Members (see attachment)

As part of San Juan Regional Medical Center's commitment to remain a sustainable organization to meet the needs of San Juan County and surrounding communities, we are changing our business practices to improve our ability to receive payments for services rendered. Beginning January 1, 2018, payments or payment arrangements will be required for all scheduled services before the services are rendered. The only exception is those seeking care in the Emergency Department.

All BCBS Contracted Providers:  November 2017 Blue Review

November 2017

In this month's Blue Review: HEDIS Record Review,
Resources for diabetic patients, and much more.

Please share this newsletter with others in your group or practice.

2018 HEDIS® Medical Record Review Begins February 2018
BCBSNM will be collecting medical records in February of 2018 for the annual HEDIS record review. Read more

New Medical Record Retrieval Vendor for Out-of-Area Blue Plan Member Records
Effective Jan. 1, 2018, Inovalon will replace Verscend as the new medical record retrieval vendor. Between now and Jan. 1, 2018, you may see requests from both Verscend and Inovalon as the transition is completed on Jan. 1, 2018.
Read more

New Online Magazine Spotlights Emerging Episodes of Care Payment Model
Visit our new online magazine
Making the Health Care System WorkSM, which explores major health care topics in the national news and how we can all work together to improve the health care system. A recent article looks into moving away from the traditional fee-for-service model and toward viewing and paying for all the care associated with a single procedure or condition as one product. Read more

BCBSNM Celebrates LGBTQ Inclusion
Our responsibility to an ever-increasing, diverse member base led us to work with our lesbian, gay, bisexual, transgender and questioning/queer (LGBTQ) employees to understand the health care needs of the LGBTQ population.
Read more

Important Information on ABA Forms, Authorizations and Payment
BCBSNM has made updates to Applied Behavioral Analysis forms, authorizations and payments. Read more

Billing for Binaural Hearing Aids
Binaural hearing aid codes allow providers to save time by billing a single CPT code for members requiring bilateral hearing aids; remember that these codes should never be billed twice for the same service. Read more

How to Find BCBSNM Resources in AvailityTM Payer Spaces
The BCBSNM Payer Spaces section contains payer-specific in-house applications, resources, and links to the BCBSNM Provider website for quick access to pertinent information. Read more

Adhering to Vaccination Guidelines
To help keep BCBSNM members safe, it is important to adhere to guidelines recommended by the U.S. Food and Drug Administration and Advisory Committee on Immunization Practices. Read more

Make Your Focus Clear on Eye Care with Retinopathy Screening
Patients with type 1 or type 2 diabetes may be screened for diabetic retinopathy by having a dilated eye exam, ophthalmoscopic exam or fundus photography by an optometrist or ophthalmologist each year. Read more

Important Notice Regarding Allergy Services
BCBSNM expects all providers to follow CPT specifications for diagnosis, treatment, and management of all services and that care be reflected by appropriate documentation in the patient’s medical record. Read more

Documentation Guidelines for Laboratory Audit/Review
Incomplete or illegible records and documentation for laboratory services may result in a denial of payment for services. Read more

Operational Effectiveness: Better and Faster Ways to Do Business Together
In the months ahead, we are rolling out new ways to work together, which have been created with efficiency and effectiveness in mind. As we systematically deploy new processes and programs, we are helping providers realize the ability to integrate these new efficiencies into existing workflows with relative ease. Read more

Blue Cross Community CentennialSM (Medicaid)

Not yet contracted?
Providers who are participating in commercial BCBSNM products are not automatically participating providers in Blue Cross Community Centennial. If you are interested in becoming a Blue Cross Community Centennial provider, please call 505-837-8800 or 1-800-567-8540.

Reminder: Update your Enrollment Information
Due to Centennial Care requirements, all enrollment information (changes to demographics, licensure or certification, provider status, etc.) must be updated on the
NM Medicaid Provider Web Portal.

National Diabetes Month – November 2017
BCBSNM is pleased to announce a new initiative that will engage our members to take proactive steps in their diabetic wellness. Read more

Living365SM Diabetes Education Classes
Blue Cross and Blue Shield of New Mexico (BCBSNM) is working with Albertsons grocery stores around New Mexico to provide complimentary diabetes coaching classes for Medicare Advantage and Medicaid members starting in November. Read more

Cold Weather Asthma: Prevention Through Education
Asthma exacerbation is more common with colder air during the winter months, and our members diagnosed with asthma may need educational reinforcement. Read more


Living365SM Diabetes Education Classes
Blue Cross and Blue Shield of New Mexico (BCBSNM) is working with Albertsons grocery stores around New Mexico to provide complimentary diabetes coaching classes for Medicare Advantage and Medicaid members starting in November. Read more

Federal Employee Program (FEP)

FEP Plan Update
As of Jan. 1, 2018, BCBSNM will no longer offer the Federal Employee Health Benefits (FEHB) of New Mexico BlueHMO Preferred plan. BCBSNM will continue to administer two FEHB PPO plans through its Blue Cross and Blue Shield Service Benefit Plan. Read more

Provider Resources

BCBSNM Website
It’s important for you to stay informed about news that could affect your practice. Blue Cross and Blue Shield of New Mexico (BCBSNM) offers many ways to stay informed via our website, bcbsnm.com/provider, and our provider newsletter, Blue Review. Read more

Medical Policy Updates
Approved new or revised Medical Policies and their effective dates are usually posted on our website the first and fifteenth of each month. These policies may impact your reimbursement and your patients’ benefits. These policies are located under the Standards & Requirements tab at bcbsnm.com/provider.

Claims inquiries?
Our Provider Service Unit (PSU) handles all provider inquiries about claims status, eligibility, benefits, and claims processing for BCBSNM members. Call 888-349-3706 For out-of-area claims inquiries, please call the BCBSNM BlueCard PSU at 800-222-7992.
Network Services Contacts and Related Service Areas
Network Services Regional Map

Do we have your correct information?
Maintaining up-to-date contact and practice information helps to ensure that you are receiving critical communications and efficient reimbursement processes. Please complete our quick and easy
online form for any changes to contact or practice information.

Member Rights and Responsibilities
BCBSNM policies help address the issues of members participating in decision making regarding their treatment; confidentiality of information; treatment of members with dignity, courtesy and a respect for privacy; and members’ responsibilities in the practitioner-patient relationship and the health care delivery process. Read more




You can find Blue Review online!
We want your feedback on
Blue Review! Have suggestions for future articles? Drop us a line anytime: NM_Blue_Review_Editor@bcbsnm.com.




Did you know?  Timely filing for most payers on corrected and secondary claims is 90 days from the date of the first EOB.

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