Blue Review, Issue 8, 2009
Please take a moment to respond to this brief survey. We will be offering surveys about Blue Review and our website throughout the year via the newsletter.
Blue Review Survey
BCBSNM Clinical and Preventive Care Guidelines available on request
BCBSNM makes its Clinical Practice Guidelines and Preventive Care Guideline Summaries available to you in a variety of ways. We publish guidelines in Blue Review every year; we include a link in your Blues Provider Reference Manual; and we send newly credentialed physicians our guidelines with their initial credentialing approval packets. You may also access our guidelines on our website.
Some physicians may prefer a paper version of the guidelines. To request a hard copy, call the Quality Management and Improvement Department at 800-205-9926 and select option 1 to reach our Quality Improvement coordinator.
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.
View full story
Physicians: We’re changing our clinical review process
Please do not send faxes for clinical reviews unless specifically requested by our nurse reviewers. Our nurse reviewers will determine if there is a need for specific clinical information and will contact the facility to schedule a telephone review. Thank you in advance for helping us to expedite our clinical review process. If you have any questions, please call BCBSNM Health Services at 800-325-8334.
Propylthiouracil (PTU) and liver injury
The Food and Drug Administration (FDA) notified health care professionals of the risk of serious liver injury, including liver failure and death, with the use of propylthiouracil (PTU) in both adults and pediatric patients. Reports to FDA’s Adverse Event Reporting System (AERS) suggest that there is an increased risk of hepatotoxicity with PTU when compared to methimazole (MMI). FDA has identified 32 AERS cases (22 adults and 10 pediatric) of serious liver injury associated with PTU use.
View full story
Share your wisdom with your patients: Write a short column for our member newsletter
We’re seeking health care professionals in the BCBSNM network who are interested in writing a 300- to 600-word article for a future “Ask a health care professional” column in our quarterly member newsletter, Blues Healthline. The column relates to the issue’s theme (previous issues have covered weight loss, asthma, and diabetes) and focuses on specific topics that you encounter frequently in your practices. You don’t need perfect writing skills – our editor will help polish your words to a brilliant shine. While there is no remuneration for writing this column, you will enjoy the prestige of seeing your words, name, and photograph in a professionally produced newsletter that is mailed to more than 125,000 households.
For more information about the “Ask a health care professional” column, please contact Michelle McRuiz, Blues Healthline editor, at (505) 816-4290 or via e-mail. Note: To be eligible, you must be contracted with BCBSNM.
Office Staff
Billing NPI error corrected on payment transactions; implementation delayed
Since the implementation of NPI on May 23, 2008, the billing NPI field on the Provider Claim Summary (PCS) and the Electronic Remittance Advice (ERA), which is sent in 835 format, has been populated incorrectly with the rendering provider NPI due to an anomaly in the system.
View full story
ERA and EPS: A winning combination
In previous articles, we’ve outlined the definitions, advantages, and enrollment process for Electronic Funds Transfer (EFT), Electronic Remittance Advice (ERA), and Electronic Payment Summary (EPS). Discussions in recent provider workshops, webinars, and site visits have helped us to identify some of the concerns that may be preventing some providers from taking advantage of these paperless transactions, especially ERA and EPS. Here are some of the comments we’ve heard, along with explanations to help clarify some of the technical details:
View full story
In the know: Helpful hints for Electronic Remittance Advice (ERA) and Electronic Payment Summary (EPS) enrollees
Providers who joined or left the BCBSNM network, June 2009
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. For out-of-area claims inquiries, please call the BlueCard PSU at 800-222-7992.
Blue Medicare PPOSM
Medicare Part D formulary updates
The formulary change list below includes changes that have occurred to the BCBSNM Medicare Part D formulary in the second quarter of 2009. This list is updated regularly by our pharmacy benefits manager, Prime Therapeutics.
View full story
Reminder: How to submit Blue Medicare PPO claims correctly
Please follow these guidelines when filing your Blue Medicare PPO claims.
View full story
BlueSaludSM
BlueSalud Member Consumer Advisory Board: Join us!
We need providers to join the BlueSalud Consumer Advisory Board (CAB). CAB gives you the opportunity to share your provider experiences with our BlueSalud membership so we can better serve you. The next CAB meeting is September 30 at noon (location to be determined). For more information and to RSVP, contact Christine Rocha at (505) 816-4316 or by e-mail.
Free infant car seat program for BlueSalud members
We believe it is important for expecting moms to receive regular prenatal visits to ensure the best health for their babies. Now pregnant BlueSalud members can earn points toward an infant car seat by visiting their physicians regularly during their pregnancies and enrolling in our Special Beginnings® program.
View full story
BlueSalud and DME: State regulations that may affect your practice
Following are some of the state regulations that affect durable medical equipment (DME) providers and DME services provided to our BlueSalud membership.
View full story
Required preventive health screenings for BlueSalud members
Following are some of the preventive health screenings required by Medicaid for BlueSalud members, per the Medicaid Managed Care Standards for Preventive Health Services (New Mexico Administrative Code 8.305.8.16).
View full story
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 8, 2009
