Our Vision:


© Copyright San Juan Independent Practice Association, 2016. All Rights Reserved.


Recent News: UPDATE 6.14.2017 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!

The information contained within this message is for your use, in order to inform you of any changes that may be occurring at the San Juan IPA, or within the medical community. Please read each message carefully, as they contain important information that may directly affect your practice.


San Juan IPA SPECIAL Alert!





ALL United Contracted Providers:  Provider Information Expo

Registration due by today, 06/23/2017 and meeting is on 07/14/2017 in Albuquerque.

 

Expo is open from 8:30 am to 3:00 pm so come when it’s convenient for you. Multiple sessions will be set up on different topics – focus on the ones most applicable to your practice. Ask questions of our expert staff that are most relevant to your needs Visit all stations and be entered for door prizes!

Albuquerque Marriott

2101 Louisiana Boulevard, NE

Albuquerque, NM 87110

July 14, 2017





ALL BCBS Contracted Providers:  Additional Availity Training Webinars / Webinars are still available

https://www.bcbsnm.com/provider/news/2017_06_13.html


Blue Cross Community Centennial: Additional AvailityTMTraining Webinars

June 13, 2017

Beginning June 17, 2017, providers submitting eligibility and benefits and claim status inquiries via Availity for Blue Cross Community Centennial members should use the new drop-down payer option of "Blue Cross Community Centennial." Previously, Availity users verified transactions for these members by utilizing the drop-down payer option of "BCBSNM Medicaid."

This process change is in addition to the Blue Cross Community Centennial electronic payer ID change, which was effective May 20, 2017. Professional and Institutional providers submitting Blue Cross Community Centennial electronic claims must now use the new payer ID, MC721. If these claims are submitted via direct data entry through the Availity Web portal, providers should utilize the drop down payer option of "Blue Cross Community Centennial."

JOIN US FOR A WEBINAR! Blue Cross and Blue Shield of New Mexico (BCBSNM) is hosting three educational webinars for providers to learn how to request eligibility and benefit and claim information for these members via Availity. In addition, a brief electronic claim submission refresher will be included during the webinar. New and existing Availity users are highly encouraged to attend. To register for a complimentary webinar, select a session date and time below.

June 20, 2017 – 1p.m. to 2 p.m. 

June 22, 2017 – 1p.m. to 2 p.m. 

June 29, 2017 – 1p.m. to 2 p.m. 

BCBSNM supports an array of online tools that are available to registered Availity users at no additional cost. To register, simply go to availity.com , select "Register," and complete the online application today. For further assistance, contact our Provider Education Consultants at PECS@bcbsnm.com.



REMINDER:  UnitedHealthcare Contract Update: 

San Juan IPA and UnitedHealthcare are continuing negotiations.  This contract is due to terminate on July 14, 2017, but due to vacations negotiations must be completed by close of business Thursday, June 29thMembers may consider beginning to notify patients that they may be out of network by this date if negotiations are not finalized.  San Juan IPA submitted an initial proposal to UHC in March, and to-date has not received a counterproposal.  San Juan IPA has sent multiple notifications and to UHC’s contracting team warning them of the deadline quickly approaching.



REMINDER:  All San Juan IPA Contracted Members:  Change in Balloting Process

Effective 07/01/2017, San Juan IPA will be implementing a new policy during the balloting process.  The new policy was approved by the San Juan IPA Board of Directors.  All future ballots will have “Response deadline dates” listed.  Two attempts to contact your office will be made and if no response is received in writing within the deadline date, your office will be considered non-participating and a notification will be provided to the health plan we are balloting.  If your office was not previously participating with the health plan your status will not change.  Practices may submit a ballot at any time after the response deadline date however, you may be subject to a gap in contracting as contracting effective dates will be at the health plan's discretion. 



REMINDER:  ALL SJIPA Contracted Providers:  Volunteers Needed

Calling all volunteers!  San Juan IPA has developed a series of training videos for our members and are asking for volunteers to review them.  You can review any or all of them; we are looking for feedback including:


How was the level of content?  (Needs more, needs less)

Is the content timely?

How was the speed of the presentation?

Did the webinar meet the general education level of the audience?

Was the content relevant?

What improvements would you suggest?  (Go to town here- the presenter needs to do “X”, content just isn’t worth it, needs more development, less jargon, you wanted to rip your ears off with pliers…whatever we need to know.)


Please contact the IPA if you’re interested in helping us develop new member content!



Did you know?  To prevent insurance fraud, you should ask for identification and compare the name on the ID to the name on the insurance card provided.





The information contained within this message is for your use, in order to inform you of any changes that may be occurring at the San Juan IPA, or within the medical community. Please read each message carefully, as they contain important information that may directly affect your practice.


San Juan IPA SPECIAL Alert!





Summit Administrators Contract Update:

San Juan IPA has completed the negotiations with Summit (Native American Schools) and have sent amendments for signature.  As soon as we receive those back we will begin the ballot process.  **Please note:  Not all IPA members will receive ballots for Summit; only those in the San Juan County area will be under contract.**  The new contract will be effective from July 1, 2017 to June 30, 2019.



UnitedHealthcare Contract Update: 

San Juan IPA and UnitedHealthcare are continuing negotiations.  This contract is due to terminate on July 14, 2017.  Members may consider notifying patients that they may be out of network by this date.  San Juan IPA had sent a contract proposal back in March, and to-date has not received a counterproposal.  We do have calls scheduled to hopefully work through the final issues and have a signed contract before the end of June but at this point and absent a counteroffer, the level of confidence is not high.



ALL SJIPA Contracted Providers:  Volunteers Needed

Calling all volunteers!  San Juan IPA has developed a series of training videos for our members and are asking for volunteers to review them.  You can review any or all of them; we are looking for feedback including:


How was the level of content?  (Needs more, needs less)

Is the content timely?

How was the speed of the presentation?

Did the webinar meet the general education level of the audience?

Was the content relevant?

What improvements would you suggest?  (Go to town here- the presenter needs to do “X”, content just isn’t worth it, needs more development, less jargon, you wanted to rip your ears off with pliers…whatever we need to know.)


Please contact the IPA if you’re interested in helping us develop new member content!



REMINDER:  All San Juan IPA Contracted Members:  Change in Balloting Process

Effective 07/01/2017, San Juan IPA will be implementing a new policy during the balloting process.  The new policy was approved by the San Juan IPA Board of Directors.  All future ballots will have “Response deadline dates” listed.  Two attempts to contact your office will be made and if no response is received in writing within the deadline date, your office will be considered non-participating and a notification will be provided to the health plan we are balloting.  If your office was not previously participating with the health plan your status will not change.  Practices may submit a ballot at any time after the response deadline date however, you may be subject to a gap in contracting as contracting effective dates will be at the health plan's discretion. 



Did you know?  All practitioners must notify the IPA of any changes to your practice or provider profile either a minimum of 45 days prior to the change, such as a practice address change, or 20 days after the change, such as a change in licensure or status.  Reporting changes are a requirement of the IPA Membership Agreement and the payers you have contracted with.  “Changes” may include a change of address, medical malpractice limits or settlements, licensure changes, or privileging status.




The information contained within this message is for your use, in order to inform you of any changes that may be occurring at the San Juan IPA, or within the medical community. Please read each message carefully, as they contain important information that may directly affect your practice.


San Juan IPA SPECIAL Alert!





Summit Administrators Contract Update:

San Juan IPA has completed the negotiations with Summit (Native American Schools) and have sent amendments for signature.  As soon as we receive those back we will begin the ballot process.  **Please note:  Not all IPA members will receive ballots for Summit; only those in the San Juan County area will be under contract.**  The new contract will be effective from July 1, 2017 to June 30, 2019.



UnitedHealthcare Contract Update: 

San Juan IPA and UnitedHealthcare are continuing negotiations.  This contract is due to terminate on July 14, 2017.  Members may consider notifying patients that they may be out of network by this date.  San Juan IPA had sent a contract proposal back in March, and to-date has not received a counterproposal.  We do have calls scheduled to hopefully work through the final issues and have a signed contract before the end of June but at this point and absent a counteroffer, the level of confidence is not high.



ALL SJIPA Contracted Providers:  Volunteers Needed

Calling all volunteers!  San Juan IPA has developed a series of training videos for our members and are asking for volunteers to review them.  You can review any or all of them; we are looking for feedback including:


How was the level of content?  (Needs more, needs less)

Is the content timely?

How was the speed of the presentation?

Did the webinar meet the general education level of the audience?

Was the content relevant?

What improvements would you suggest?  (Go to town here- the presenter needs to do “X”, content just isn’t worth it, needs more development, less jargon, you wanted to rip your ears off with pliers…whatever we need to know.)


Please contact the IPA if you’re interested in helping us develop new member content!



REMINDER:  All San Juan IPA Contracted Members:  Change in Balloting Process

Effective 07/01/2017, San Juan IPA will be implementing a new policy during the balloting process.  The new policy was approved by the San Juan IPA Board of Directors.  All future ballots will have “Response deadline dates” listed.  Two attempts to contact your office will be made and if no response is received in writing within the deadline date, your office will be considered non-participating and a notification will be provided to the health plan we are balloting.  If your office was not previously participating with the health plan your status will not change.  Practices may submit a ballot at any time after the response deadline date however, you may be subject to a gap in contracting as contracting effective dates will be at the health plan's discretion. 



Did you know?  All practitioners must notify the IPA of any changes to your practice or provider profile either a minimum of 45 days prior to the change, such as a practice address change, or 20 days after the change, such as a change in licensure or status.  Reporting changes are a requirement of the IPA Membership Agreement and the payers you have contracted with.  “Changes” may include a change of address, medical malpractice limits or settlements, licensure changes, or privileging status.

Member Login:

Dental