Blue Review, issue 9, 2009
From the director’s chair: RBRVS, Annual Provider Satisfaction Survey, Availity®, and BlueSaludSM
You recently received a letter that BCBSNM will be adopting the 2009 Resource-Based Relative Value Scale (RBRVS) Relative Value Units (RVUs) effective October 1, 2009. In addition to this letter, we included a list of your most frequently used CPT codes, the previous RVU and reimbursement, and the 2009 RVU and reimbursement rate. We hope this information will be helpful to you in determining your reimbursement for these services after October 1. We appreciate the feedback you gave us, and we have responded to your recommendations.
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The quality of care your patients receive: HEDIS® results
BCBSNM uses the nationally standardized and independently audited Healthcare Effectiveness Data and Information Set (HEDIS) to assess the quality of care received by BCBSNM members enrolled in most of our HMO or PPO lines of business, as well as our BlueSalud business.
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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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Video stories at Be Smart. Be Well.® address high-risk pregnancies
Studies show one in five pregnancies is high-risk. Pregnancy can be an exciting time, but for women at risk, this exciting event can also be a stressful one. It’s important for women to educate themselves about these possible risks. Managing Pregnancy Risks is the latest topic on Be Smart. Be Well., offering information and resources to help women avoid pregnancy complications and premature delivery.
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Office Staff
Blues Provider Reference Manual updates
The Blues Provider Reference Manual on our website is updated throughout the year. You can find a summary of the changes made so far in 2009 in the Table of Contents with Changes and Updates Preface. Please note: These changes might not be current in the print and CD-ROM versions. Always refer to our Provider Library for the most current information.
Providers who have joined and left the BCBSNM network, July 2009
New implementation date for the billing NPI error correction on payment transactions
In the August issue of Blue Review, we informed you about our plans to correct our billing NPI error in the Provider Claim Summary (PCS) and the Electronic Remittance Advice (ERA). Any medical group or individual provider that is incorporated, and bills electronic claims with both a billing type 2 NPI and a rendering type 1 NPI, will begin seeing this correction reflected on completed claims that are received on or after August 24, 2009. Any claims received prior to this date will still have the rendering provider NPI in the billing field.
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
Notice of termination of Medicare Advantage Amendment, effective December 31, 2009
The following letter was mailed to Blue Medicare PPO providers and posted to our website on August 7, 2009.
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Medicare Part D pharmacy update: FDA takes action to ensure safe use of products containing propoxyphene
On July 7, 2009, the Food and Drug Administration (FDA) announced it would allow the continued marketing and sale of propoxyphene-containing products on the U.S. market but was taking several actions to reduce the risk of overdose and other adverse effects.
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BlueSaludSM
Standards for medical records
Participating BlueSalud health care providers must have a system in place for maintaining medical records for a period of not less than ten years that conforms to regulatory standards. Each medical encounter, whether direct or indirect, must be comprehensively documented in the member’s medical chart.
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BlueSalud 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 at the BCBSNM Full Service Unit, 4373 Alexander Boulevard NE in Albuquerque. To RSVP, contact Christine Rocha at (505) 816-4316 or by e-mail. Please RSVP by September 23.
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.
BlueSalud services are funded in part under contract with the State of New Mexico.
