The following online tools are available to you and your practice at no cost. They are designed to help you streamline billing and evaluate costs.
You can access many of the web-based tools listed below through Availity® Essentials. If you don’t yet have an Availity Essentials account, register for an account here at no cost to you or call Availity Client Services at 800-282-4548.
Some tools may not be available for government programs. Contact your Provider Network Representative if you have questions.
Altruista Health’s GuidingCare®
Use this care management tool in Availity Essentials to monitor rendered services, activates, quality measures and care plans for Blue Cross Community CentennialSM members. Learn More
Attachments – Recommended Clinical Review Requests
Submit recommended clinical review requests handled by BCBSNM with this tool in Availity Essentials. Learn More
Authorizations
Submit prior authorization requests handled by BCBSNM with this tool in Availity Essentials. Learn More
BlueApprovRSM
Access this tool in Availity Essentials to submit inpatient and outpatient prior authorization requests and check the status of your requests. You can also use BlueApprovR to submit recommended clinical review requests. Learn More
Claim Inquiry Resolution – High-Dollar, Pre-Pay Reviews
Access this tool in our Electronic Refund Management system through Availity Essentials. Through CIR you can submit inquiries related to high-dollar, prepay review requests for most BlueCard® out-of-area and local New Mexico claims (medical records and itemized bills) handled by BCBSNM. Learn More
Claim Reconsideration Requests
Electronically submit claim reconsiderations for situational finalized claim denials − including BlueCard out-of-area claims − using Availity Essentials' Dispute Claim capability. It is anchored off the enhanced Claim Status tool. Learn More
Claim Status
Manage and resolve claims processed by BCBSNM using this Availity Essentials tool. It offers enhanced, real-time claim status information. Learn More
Clear Claim ConnectionTM
Learn how coding combinations on a particular claim may be evaluated during the adjudication process using this tool in Availity Essentials. C3 mirrors the logic behind BCBSNM's code-auditing software. Learn More
CoverMyMeds®
Use this tool to submit electronic prior authorization requests for prescription drugs that are part of the pharmacy PA program. Learn More
DNoA Connect
DNoA Connect is a provider self-service tool where dental offices can conveniently connect to patient information for members with BlueCare DentalSM.
Electronic Claim Submission
Quickly submit electronic professional (ANSI 837P) and facility or institutional (ANSI 837I) claims or encounters to BCBSNM using this Availity Essentials tool. Learn More
Electronic Clinical Claim Appeal Requests
Electronically submit appeal requests for specific clinical claim denials through this dispute tool in Availity Essentials. Learn More
Electronic Refund Management
Use this tool to simplify overpayment reconciliation and related processes. You can access it in Availity Essentials. Learn More
Eligibility and Benefits
Quickly obtain detailed benefits information for our members using Availity Essentials’ Eligibility and Benefits Inquiry. This tool provides co-payment, co-insurance, deductible and other important information.
Verify membership and check coverage details for every patient at every visit, before you administer treatment.
For additional details, refer to the Availity Eligibility and Benefits User Guide.
Fee Schedules (Professional Providers)
With the Availity Essentials Fee Schedule Listing tool, participating professional providers can electronically request up to 20 procedure codes and immediately receive the contracted price allowance for the services performed. Learn More
Interpreter Services
Interpreter services allows providers to arrange interpretative services for Limited English Proficient individuals and interpretative services for patients who qualify under the Americans with Disabilities Act. Learn More
Manage My Organization
Administrators and administrator assistants can use this tool in Availity Essentials to add, edit and delete provider information within your organizations for easy data entry when submitting transactions via Availity handled by BCBSNM. Learn more
Medical Record Status Viewer
Confirm receipt of up to four of the most recent medical records submitted by mail or fax to BCBSNM for claim processing and prior authorizations. Access this tool in Availity Essentials. Learn More
Message This Payer
Send secure messages to BCBSNM in Availity Essentials about claim management questions and follow along with the conversation history. Learn More
National Drug Code Units Calculator
Use this tool in Availity Essentials to easily convert applicable classified or specified Healthcare Common Procedure Coding System or Current Procedural Terminology (CPT®) codes to NDC units. Learn More
OptiNet® Assessment Tool
Use this tool to provide modality-specific data from imaging. Developed by Carelon Medical Benefits Management, this tool is an enhancement to our Advanced Imaging Utilization Management program, which Carelon administers for BCBSNM. Learn More
Patient Care Summary
Access this tool in Availity Essentials for an electronic health record based on the last 24 months of claims data. BCBSNM collects the claims-based information from physicians, pharmacies, labs and other health care providers. Learn More
Patient Cost Estimator
Using this Availity Essentials tool, professional and institutional providers can estimate our members’ potential out-of-pocket costs in real time. Learn More
Patient ID Finder
Obtain our members’ ID number and group number by entering patient-specific date elements using this tool in Availity Essentials. Learn More
Physician Efficiency, Appropriateness, & QualitySM Program
Our PEAQSM program evaluates physician performance in a transparent and multidimensional way. Learn More
Provider Claim Summary
You can readily view, download, save and print Provider Claim Summary reports online using this application in Availity Essentials. Learn More
Provider Correspondence Viewer
Participating providers with BCBSNM can view, download and save specific documents related to the NPI and Tax ID associated with your Availity Essentials registration. Access this tool in Availity Essentials. Learn More
Provider Data Management (PDM)
Professional, facility and ancillary providers can quickly update, validate and attest to the accuracy of your information using this Availity Essentials tool. Learn More
Remittance Viewer
Providers and billing services can view and help reconcile claim data provided by BCBSNM in the 835 Electronic Remittance Advice using this Availity Essentials tool. Learn More
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 BCBSNM. BCBSNM makes no endorsement, representations or warranties regarding third party vendors and the products and services they offer.