Oct. 9, 2024
Beginning Dec. 9, 2024, we may require an itemized bill for some commercial member claims of $100,000 or more to ensure consistency in processing. This applies to non-diagnosis related group facility claims for commercial members. An itemized bill helps ensure an accurate claim payment.
Also beginning Dec. 9, 2024, we will expand our review of select inpatient DRG claims. The review will check for medical appropriateness and compliance with ICD-10 procedure coding system guidelines. For these claims, we may ask you to submit medical records.
How to Submit Itemized Bills: You may submit itemized bills or medical records electronically using our Claim Inquiry Resolution tool. Include the claim number for quicker review and turnaround time.
Important Reminder: Check eligibility and benefits through Availity® Essentials or your preferred vendor portal, prior to rendering services.
More Information
Refer to our Inpatient/Outpatient Unbundling Clinical Payment and Coding Policy for more information. If you have questions, contact your provider network consultant.
Availity is a trademark of Availity, LLC, a separate company that operates a health information network to provide electronic information exchange services to medical professionals. Availity provides administrative services to Blue Cross and Blue Shield of New Mexico. BCBSNM makes no endorsement, representations or warranties regarding any products or services provided by third party vendors.