MedicaidAdministrativeMedium impact
We’re Reviewing Medicaid Home Health and Personal Care Service Claims Denied Due to Membership Status
BCBS New Mexico·NM·Reimbursement
Effective date
Mar 27, 2026
We identified it
Jun 18, 2026
Summary
Blue Cross Blue Shield of New Mexico experienced a system error that incorrectly denied Medicaid home health and personal care service claims due to membership status issues. The issue was resolved on March 27, 2026, and BCBSNM is processing corrections with full adjustments expected by mid-April 2026.
Action Required
By mid-April 2026: Billing team should use the Claim Status tool in Availity Essentials to review any Medicaid home health or personal care service claims that were denied for membership status errors between the system update and March 27, 2026. Contact the electronic visit verification team for questions about specific claims. No resubmission required as BCBSNM is automatically processing corrections.