A message from Kurt Shipley, Vice President, New Mexico Programs and Network Management
Whenever we are faced with a difficult decision at HCSC, we have to ask only one basic question in order to help us determine the best way to proceed: What’s best for our members?
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Explore your paperless possibilities with BCBSNM
It’s easy to switch from paper checks and EOBs to electronic funds transfer, electronic remittance advice, and electronic payment summary. You’ll save time, effort, and resources!
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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 – and in this newsletter. These policies may impact your reimbursement and your patients’ benefits.
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Drug List updates and step therapy requirements
Learn about recently recommended changes to the BCBSNM Drug List and requirements for step therapy.
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CDC advisory: Influenza A
Preliminary CDC data indicate that the prevalence of influenza A (H1N1) virus strains resistant to the antiviral medication oseltamivir is high. Therefore, CDC is issuing interim recommendations for antiviral treatment and chemoprophylaxis of influenza during the 2008-09 influenza season.
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The JUPITER trial
The JUPITER trial attempts to answer the question, “Why do half of all myocardial infarctions and strokes occur in apparently healthy men and women with levels of LDL that are below currently recommended thresholds of treatment?” The study addresses the biomarker high-sensitivity C-reactive protein (hs-CRP), an inflammatory marker that has long been linked to an increased risk of adverse cardiovascular events.
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Update! New member ID card implementation
Our initial goal was that all new ID cards issued to members must be in the new format by January 1, 2009. However, we have had to extend this timeframe to the end of the first quarter of 2009.
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Medical ID theft – a new threat to your practice (part two)
Medical identification (ID) theft is the fastest-growing form of ID theft in the United States. It can cause bodily harm to patients, ruin a person’s credit, and cause disruptions in your billing and medical records systems.
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Are you billing unlisted J-codes?
Beginning February 1, 2009, to ensure providers are billing correctly and are being reimbursed properly, BCBSNM will begin checking the NDC numbers billed with unlisted J-codes. What does this mean for our providers?
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We are here to help you
In each issue of Blue Review, we profile employees of Provider Network Management, the Provider Service Unit (PSU), the Provider Access and Servicing Strategy (PASS) unit, or Health Care Management (HCM), describing what they do for you, the provider. This issue features Karen Smoot, Senior Director of Network Management.
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Year-end reader survey
We appreciate all the survey responses we received in December 2008, and will use the data to determine ways to make Blue Review more interesting and valuable to our providers and their staffs.
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Office Staff
Please keep your contact information current!
Looking for a handy way to notify BCBSNM of your new address, phone number, e-mail, or services? You can quickly e-mail your changes to Network Management by using the convenient Update Your Contact Information online form.
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Update! Procedure code 96110
Beginning February 16, 2009, any date of service submitted with procedure code 96110 for Developmental testing, limited, will not bundle in Clear Claim Connection™ (C3) when billed with any other evaluation and management (E&M) code.
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In the know: Our electronic payer ID
Electronic claims submitted to BCBSNM, including BlueSalud, must have this ID.
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Frequently asked questions
Our website features a list of FAQs that are helpful to providers and their staffs. We update this information continuously, so please refer to the FAQs often.
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Provider network addition
Effective February 1, 2009:
Performance Cardiology, PC
Bruce Andrea, MD
Valerie Mehaffie, PA
1201 Main Avenue, Suite 203
Durango, CO 81301
(970) 403-0555
Claims inquiries? Call the Provider Service Unit
Our PSU handles all provider inquiries about claims status, eligibility, benefits, and claims processing for BCBSNM members.
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Network Management contacts and related service areas
Network Management professional contracting service areas map
Blue Medicare PPOSM
Blue Medicare PPO 2009 benefits
Blue Medicare PPO has made updates to its three benefit plans (Value, Advantage, and Premier).
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Blue Medicare PPO now offers acupuncture benefits
Effective January 1, 2009, Blue Medicare PPO began offering acupuncture benefits for its Value, Advantage, and Premier Medicare Advantage plans.
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Updated! Blue Medicare PPO claims submission information
Here’s how to get your Blue Medicare PPO claims paid efficiently.
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Not yet contracted for Blue Medicare PPO?
Providers who are participating in commercial BCBSNM products are not automatically considered participating providers in Blue Medicare PPO.
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BlueSaludSM
Using the Notification of Birth form
The Notification of Birth form is used to report the birth of an infant to a Medicaid-eligible mother. Using the form will facilitate payment to providers for the services rendered to the newborn.
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How to expedite your BlueSalud claims
BCBSNM encourages BlueSalud participating physicians, professional providers, and facility providers to submit claims within 90 days of the date of service using the standard CMS-1500 or UB-04 claim form, or the appropriate electronic format.
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Encounter reporting
The New Mexico Human Services Department (HSD) requires BCBSNM to report all services rendered to BlueSalud members. This encounter reporting is critical to BlueSalud’s success.
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Not yet contracted for BlueSalud?
Providers who are participating in commercial BCBSNM products are not automatically considered BlueSalud participating providers.
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