Behavioral Health Care Management Program
Blue Cross and Blue Shield of New Mexico (BCBSNM) manages behavioral health services for all members who have behavioral health benefits through BCBSNM. Behavioral health services for New Mexico BlueSaludSM members are administered by OptumHealthSM New Mexico as the statewide behavioral health entity.
Behavioral health care management is integrated with our medical care management program, as part of Blue Care Connection® (BCC), to help members access their behavioral health benefits and to improve coordination of care between medical and behavioral health providers.
This program will help BCBSNM clinical staff identify members who could benefit from co-management earlier, and may result in:
- Improved outcomes
- Enhanced continuity of care
- Greater clinical efficiencies
- Reduced costs over time
Some members* may be referred to other BCC medical care management programs that are designed to help identify and close potential gaps in care through evidence-based and member-focused approaches to health care and benefit decisions.
All behavioral health benefits are subject to the terms and conditions as listed in the member's benefit plan.
* Members experiencing inpatient hospitalization, complex or special health care needs or who are at risk for medical complications may be referred to BCC programs through a variety of mechanisms such as predictive modeling, claim utilization, inbound calls, self-referrals, and physician referrals. If members do not have BCC as part of their group health plans, they will not be referred to other BCC programs.
Health Care Service Corporation, Inc. (operating through its four division; BCBS of Illinois, BCBS of New Mexico, BCBS of Oklahoma, and BCBS of Texas) Behavioral Health Care Management program was accredited for Health Utilization Management in October of 2012.
URAC, an independent, nonprofit organization, is well-known as a leader in promoting health care quality through its accreditation and certification programs. URAC offers a wide range of quality benchmarking programs and services that keep pace with the rapid changes in the health care system, and provide a symbol of excellence for organizations to validate their commitment to quality and accountability. Through its broad-based governance structure and an inclusive standards development process, URAC strives to ensure that all stakeholders are represented in establishing meaningful quality measures for the entire health care industry. For more information, visit www.urac.org. 
Members are responsible for requesting preauthorization, when preauthorization is required. Behavioral health providers or a member's family member may request preauthorization on behalf of the member. All services must be medically necessary.
Inpatient and Alternative Levels of Care
Preauthorization is required for all inpatient, residential treatment and partial hospitalization admissions.
- Elective or non-emergency hospital admissions must be preauthorized prior to admission or within two business days of an emergency admission.
- Residential Treatment Center (RTC) benefits are generally excluded from most plans; however, there are some employer groups who have elected to cover this service. To determine if RTC services are covered, call the appropriate number on the back of the member's ID card.
Outpatient
These outpatient services require preauthorization prior to initiation of service:
- Electroconvulsive therapy (ECT)
- Psychological testing
- Neuropsychological testing
- Intensive Outpatient Program (IOP)
Members are responsible for requesting preauthorization when preauthorization is required, although behavioral health providers or a member's family member may request preauthorization on behalf of the member. All services must be medically necessary.
Inpatient and Alternative Levels of Care
- Call the appropriate number on the back of the member's ID card.
Outpatient
For services requiring preauthorization listed in Preauthorization Requirements
- Members should call the behavioral health number on the back of their ID card.
- Behavioral health providers or a member’s family member may request preauthorization on behalf of the member.
Inpatient and Alternative Levels of Care
Members who do not request preauthorization and alternative levels of care for inpatient behavioral health treatment may experience the same benefit reductions that apply to inpatient medical services. Medically unnecessary claims will not be reimbursed.
Outpatient
If a member receives any of the outpatient behavioral health services listed below without preauthorization, BCBSNM will request clinical information from the provider for a medical necessity review. The member will also receive notification.
- Electroconvulsive therapy (ECT)
- Psychological testing
- Neuropsychological testing
- Intensive Outpatient Program (IOP)
- Preauthorization: Call the behavioral health number listed on the back of the member ID card
- Submit completed BH Forms to:
Blue Cross and Blue Shield of New Mexico BH Unit
PO Box 660235
Dallas, TX 75266-0235
Fax Number: Toll-free 877-361-7659
Note: Electronic submission of claims is strongly encouraged. Refer to Section 8 of the Provider Reference Manual 
for more information on filing claims electronically.
If you have questions, please contact:
- Behavioral Health Member Services (for authorizations, benefits and eligibility): 888-898-0070 FEP members: 877-783-1385
- Provider Service Unit (for benefits, eligibility and claims): 888-349-3706 FEP members: 800-722-3130
- Provider Service Representatives (for application inquiries, contractual issues, provider orientation, and education): 800-567-8540
- Contact Us
For preauthorization requirements and other highlights of the new program, view the frequently asked questions .
