Our Vision:

© Copyright San Juan Independent Practice Association, 2018. All Rights Reserved.

Recent News: UPDATED 03/12/2018
  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.

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 All BCBS Contracted providers:  Network Bulletin

Interpreting ERAs, Pharmacy Changes, Behavioral Health, and more...  |  view in Web Browser  


March 2018

In this month’s Blue Review: Interpreting ERAs, Pharmacy Changes, Behavioral Health, and more...

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

Interpreting the “PLB” Segment on the 835 ERA
There are reversals and corrections when claim adjudication results have been modified from a previous report. Adjustments in the PLB segment can either decrease the payment or increase the payment. Read more

Making the Health Care System Work Better Together
We’re working with business and thought leaders, inside and outside of our organization, to explore ways we can all work together to make the health care system work better for everyone.
Read more

Quarterly Pharmacy Changes Effective Jan. 1, 2018
Based on availability of new prescription medications and review of the pharmaceuticals market, revisions and/or exclusions were made to the BCBSNM drug lists.
Read more

March into Colon Cancer Awareness Month
Did you know that in the United States, colorectal cancer (CRC) is the second largest cause of cancer deaths for men and women? This highly preventable disease kills more than 50,000 people per year. The
Centers for Disease Control and Prevention (CDC) and U.S. Preventive Services Task Force (USPSTF) have published guidelines and information for both patients and providers regarding CRC screening. Both the CDC and the USPSTF recommend colorectal cancer screening starting at age 50. The best CRC screening test is the one that gets done! Follow the links above for more information about CRC and screening options.

Behavioral Health: Let’s Talk About It!
The first step to bridging the gap may be simply talking about behavioral health more. People with behavioral health issues should not feel embarrassed to come forward, particularly when it comes to reaching out to friends, family and health care providers who can help.
Read more

Blue Cross Community CentennialSM (Medicaid)

New Medicaid ID Numbers for Members
Starting in December 2017, HSD began issuing newly enrolled Medicaid members Medicaid ID numbers beginning with “00002”.
Read more

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.

Such services are funded in part with the State of New Mexico.

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

Signing up is easy. Go to bcbsnm.com/provider, select Update Your Information, complete the form, and click Submit.

We guard your privacy. BCBSNM treats your email address as confidential. We never sell or give your email address(es) to any third party without your permission.

Don’t have email? If you do not have an email address, please call 1-800-567-8540 or (505) 837-8800. We can mail paper copies of Blue Review to providers.

The Blue Review is posted online after the email distribution date—go to bcbsnm.com/provider, then select Blue Review.

Stay current with BCBSNM provider Education and Reference news and updates regularly.

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.




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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.