Blue Review, Issue 7, 2009
Clinical Practice Guidelines: A shared baseline
We have completed our annual update of the BCBSNM Clinical Practice Guidelines. Recognizing that practitioners are very busy, we have designed these Guidelines to be quick summaries. Each Guideline refers to a more in-depth version, which can be accessed by clicking on the appropriate links.
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From the director’s chair: Watch for the Provider Satisfaction Survey
An independent consultant, The Myers Group, is distributing the survey to a random sample of 1,500 BCBSNM contracted providers. We would greatly appreciate your participation – we want to know your concerns.
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Medical Policy updates
Approved new or revised Medical Policies and their effective dates are posted on our website the first day of each month. These policies may impact your reimbursement and your patients’ benefits.
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Drug List updates
The BCBSNM and Prime Therapeutics® Pharmacy and Therapeutics Committee met in May 2009 and recommended several changes to the BCBSNM Drug List.
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Electronic Refund Management tool unveiled
Do refunds of claim overpayments take up too much of your time? Electronic Refund Management (ERM), which will be available July 1, is a new online tool that will help you manage refunds efficiently.
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Update: Not Otherwise Classified J-codes
It is important that providers supply the necessary information for BCBSNM to properly adjudicate and reimburse claims for Not Otherwise Classified drug/injection procedures. Our claims processing units may have called your office requesting additional information about these unclassified drugs/injections when billed by your practice.
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Care Comparison tool supports transparency initiative
Later this year, we will implement a new online Care Comparison tool that will allow our members to review and compare health care and service costs for a number of procedures performed at hospitals, ambulatory surgery centers, and freestanding radiology centers in the BCBSNM provider network. This tool is a component of a transparency program that will initially focus on reporting the costs related to specific procedures rendered to BCBSNM members, as well as the total volume of each procedure performed for all payers.
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Rx for your patients’ good health: Prescription Trails
If your patients need prescriptions for regular exercise, Prescription Trails can help! The Prescription Trails program emphasizes the benefits of walking and promotes the many public trails in Albuquerque. The program is also expanding to Santa Fe.
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Preauthorization for inpatient admissions
Some providers are requesting preauthorizations without the required information. To avoid delay in obtaining the appropriate authorization, please follow these important guidelines.
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New authorization unit option added to Health Services line
In issue 6, we asked you to listen carefully to all options when calling the BCBSNM Health Services line (800-325-8334) for authorizations. Since finalizing that issue, we have added the City of Albuquerque as another option.
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Office Staff
Disclosure notice: Code auditing upgrade and modifier 59 exempt auditing
BCBSNM will make changes to the claims processing system that affects our bundling logic. We will be upgrading to McKesson ClaimCheck® Version 43 effective September 21, 2009, for all lines of business.
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Claims inquiries? Call the Provider Service Unit (PSU) at 888-349-3706
Our PSU handles all provider inquiries about claims status, eligibility, benefits, and claims processing for BCBSNM members.
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Providers who have joined and left the BCBSNM network, May 2009
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Network Management contacts and related service areas
Network Management professional contracting service areas map
Blue Medicare PPOSM
Medicare Advantage mandatory provider fraud, waste, and abuse training
CMS specifies that participation in fraud, waste, and abuse training is mandatory for anyone in the provider’s practice who may communicate with a Medicare Part C beneficiary.
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Medicare Part D pharmacy updates
This update includes a TARCEVA® safety alert and a RAPTIVA® withdrawal alert.
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BlueSaludSM
New phone number, address for State of New Mexico Fair Hearings Bureau
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Obligation to provide access to care
Please use these guidelines to ensure timely access to medical, dental, and behavioral health care for BlueSalud members.
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Required preventive health screenings for BlueSalud members
To promote the health and wellness of our members and communities, BCBSNM would like to remind providers of the Medicaid Managed Care Standards for Preventive Health Services.
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Not yet contracted for BlueSalud?
To become a BlueSalud provider, you must sign a Medicaid amendment to your Medical Services Entity Agreement (MSEA).
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BCBSNM makes no endorsements, representations, or warranties about any products or services offered by independent third-party vendors mentioned in this newsletter. The vendors are solely responsible for the products or services offered by them. If you have any questions about the products or services mentioned in this newsletter, contact the vendor directly.
Blue Review, Issue 7, 2009
