At Blue Cross and Blue Shield of New Mexico (BCBSNM), we are committed to providing support to physician practices. We’ve designed tools that health care providers find useful. Whether doing research or streamlining billing, these tools can help you evaluate costs, save time, improve service and more.

Altruista Health’s GuidingCareTM Portal via Availity® Provider Portal

Altruista Health GuidingCare is a web-based care management tool for assigned providers to monitor rendered services, activities, quality measures and care plans for Blue Cross Community CentennialSM members. GuidingCare is accessible to existing Availity administrators and assigned users in the BCBSNM-branded Payer Spaces section in the Availity Portal. Learn More

CareCost EstimatorSM

The Availity® CareCost Estimator tool is an online member liability estimator that can help professional providers estimate a patient's potential out-of-pocket costs in real-time for office and outpatient services provided to BCBSNM members. Learn More

Claim Encounter Reconciliation Application (CERA)

The Availity Claims Encounter Reconciliation Application (CERA) helps providers manage and respond to BCBSNM if potential coding opportunities are identified -- based on claims data -- for members with on and off-exchange health plans. Providers may upload and submit the necessary medical documentation to BCBSNM using CERA in the Claims & Payments menu through the Availity Portal. Learn More

Claim Inquiry Resolution

The Claim Inquiry Resolution tool allows you to communicate online with our customer advocates in some situations where previously a call or letter was required. Learn More

Claim Research Tool

The Claim Research Tool offers enhanced, real-time claim status functionality to help you manage and resolve your BCBSNM claims. Learn More

Clear Claim Connection

Clear Claim Connection is a web-based code auditing reference tool that mirrors BCBSNM edits (i.e., unbundling, mutually exclusive, and incidental). Learn More

Clinical Quality Validation (CQV) Application

Clinical Quality Validation (CQV) is a web-based application in the Availity® Provider Portal that allows providers to quickly comply with Healthcare Effectiveness Data and Information Set (HEDIS®) measures. Providers can electronically document their patient’s care and assessments to close quality HEDIS care gaps for BCBSNM members using CQV. Learn More


CoverMyMeds is an online tool for electronic completion and submission of benefit prior authorization (PA) requests for prescription drugs that are part of BCBSNM 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 Learn More

Electronic Refund Management

Electronic Refund Management  is an online tool that can help simplify your overpayment reconciliation and related processes. Learn More


iExchange is an automated precertification tool that supports direct submission and provides online approval of benefits for inpatient admissions, as well as select outpatient, pharmacy and behavioral health services 24 hours a day, seven days a week. Learn More

Patient Care Summary

The Patient Care Summary tool uses claim-based information to provide you with a consolidated view of a patient's health care history at the point of care. Learn More

Remittance Viewer

The remittance viewer offers providers and billing services a convenient way to view and help reconcile claim data provided by BCBSNM in the 835 Electronic Remittance Advice (ERA). Learn More

Reporting On-Demand

The Reporting On-Demand application allows users to readily view, download, save and/or print the Provider Claim Summary (PCS) and other reports online, at no additional cost. Learn More

Responding to Quality and Risk Adjustment Medical Records Requests Online via the AvailityTM Provider Portal

The AvailityTM Medical Attachment tool allows providers to receive electronic quality and risk adjustment medical record requests from BCBSNM. Providers can upload and submit the necessary medical records to BCBSNM using the Medical Attachment option in the Claims & Payments menu through the Availity Provider Portal. Learn More

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