Medicare AdvantageAdministrativeLow impact
Discuss Preventive Care with Members
BCBS New Mexico·NM·General
Effective date
Jul 16, 2026
We identified it
Jul 17, 2026
Summary
Blue Cross Blue Shield of New Mexico is reinforcing its expectation that providers discuss and encourage preventive care services with members, including physical exams, screenings, vaccines, and other early detection services. This is an informational/educational policy update emphasizing best practices for closing care gaps and improving HEDIS quality measures for preventive care access.
Action Required
No immediate billing changes required. This is an educational policy emphasizing provider outreach and preventive care engagement. Recommended actions for billing/administrative staff: (1) Ensure front desk and scheduling staff are aware of flexible appointment options (early morning, evening, weekend, telehealth) to facilitate preventive visits; (2) Verify that medical records documentation includes screening dates and results, as these support HEDIS quality reporting; (3) Confirm eligibility and benefits before preventive care appointments using Availity Essentials to verify preventive services are covered with no out-of-pocket costs; (4) For Medicaid members, promote awareness of free non-emergency transportation services; (5) Providers should refer to BCBSNM's preventive care guidelines and EPSDT Insights materials (available in Availity) for evidence-based recommendations. No coding changes, prior authorization modifications, or claims submission process changes are required.