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Please distribute this newsletter, which contains billing and NCQA-mandated information, to all health care providers and administrative staff that this e-mail address represents. Thank you.
Issue 11, 2009
Coverage, billing information for novel H1N1 vaccine With the impending delivery of the vaccine for the novel influenza A (H1N1) flu virus, we want to describe our coverage of charges for administering the vaccine to BCBSNM members. View full story
Revised quantity limits for antiviral medications used in the treatment and prevention of influenza BCBSNM will be relaxing the administration of quantity limits that are in place for the antiviral agents oseltamivir (Tamiflu®) and zanamivir (Relenza®), which can be used for treatment and prophylaxis of H1N1 and seasonal influenza. View full story
2009 H1N1 vaccine administration protected from tort liability BCBSNM encourages all health care providers to provide H1N1 vaccine to their patients, in accordance with the CDC guidelines, which discuss the five initial priority groups. According to the U.S. Department of Health and Human Services (DHHS), if you meet DHHS’s conditions you can administer H1N1 vaccine with immunity from tort (malpractice) liability. View full story
New educational vaccination flier for members available on our website BCBSNM has developed a flier to educate members on the benefits of receiving vaccinations for flu, pneumonia, and shingles. The flier also tells members which participating pharmacy chains offer these vaccinations and provides instructions on how to find a participating pharmacy. We have also made this flier available to members.
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
Drug List updates The BCBSNM and Prime Therapeutics Pharmacy and Therapeutics Committee met in August 2009 and recommended the following changes to the BCBSNM Drug List. View full story
New fax number for prescription drug prior authorizations BCBSNM has changed the fax number for its pharmacy prior authorization requests. The new number is (505) 816-3853. When you fax pharmacy prior authorization requests, please use the most current version of the prior authorization form and fax the form to the number above, to the attention of Pharmacy Services. This form is for both commercial and Medicaid health plan members.
Pharmacy update: Dose optimization Health care organizations are being tasked with providing costly new technologies, expanding services, and improving quality of care – all while trying to control medical and pharmaceutical costs. One simple cost-saving measure, dose optimization, refers to the identification of patients who receive multiple units of a lower-strength, once-daily maintenance medication and consolidating (or “optimizing”) the dosing regimen to an equivalent daily dosage of the same medication given as a single unit. View full story(contains survey question)
Prior authorization and concurrent review BCBSNM requires prior authorization for all inpatient admissions for all lines of business. If the admitting physician obtained prior authorization for a planned inpatient admission, BCBSNM does not need concurrent review if the patient is discharged within the pre-approved length of stay. View full story
Administration changes to Special Beginnings® prenatal program Effective November 23, 2009, Special Beginnings will be managed internally by program staff in our Health Care Management Division instead of through the independent contractor, Alere® (formerly Matria). To avoid disruptions in continuity of care, Alere representatives will continue to service current program participants until they have completed the program. 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. Each column relates to that issue’s theme, such as weight loss, asthma, and diabetes, and focuses on specific topics that you encounter 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 seeing your words, name, and photograph in a professionally produced newsletter that is mailed to more than 125,000 New Mexico 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 New Claim Research Tool can boost your claims accuracy, office efficiency A new Claim Research Tool (CRT) from Availity® gives your office staff fast, real-time access to BCBSNM claim status information, delivering greater claims accuracy and increased office efficiency in managing your account receivables with these features:
Status of multiple claims in one view
Member ID and claim (DCN) number look-ups
Patient account and group number information
Detailed line-level information including reason codes and descriptions
Related copay, deductible, and coinsurance amounts
Best of all, the CRT does all of the above with minimal training of your staff – and at no cost to you. Learn more about the CRT and get an easy-to-use Tip Sheet here. For more information on Availity services, call Availity Client Services at 1-800-AVAILITY or visit their website.
Availity is a registered trademark of Availity, L.L.C., an independent, third-party vendor.
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 BCBSNM BlueCard PSU at 800-222-7992.
Blue Medicare PPOSM Blue Medicare PPO members notified of termination On September 30, BCBSNM mailed this letter to our Blue Medicare PPO members about the termination of our Blue Medicare PPO product effective January 1, 2010.
BlueSaludSM Medicaid category 035 BlueSalud membership BlueSalud members who are eligible for Medicaid category 035 (Medical Assistance for Pregnancy-Related Services Only) are eligible to receive full BlueSalud benefits, including vision, dental, and transportation services.
BlueSalud Drug List updates The BCBSNM and Prime Therapeutics Pharmacy and Therapeutics Committee met in May and August 2009 and recommended the following changes to the BlueSalud Drug List. View full story
Join us for the BlueSalud Consumer Advisory Board meeting November 10! BCBSNM invites BlueSalud contracted providers to take part in the Consumer Advisory Board (CAB). As a member of CAB, you can share your experiences about your care of BlueSalud members and help BCBSNM better serve you.
Our next CAB meeting is Tuesday, November 10, 2009, from noon to 1 p.m. It will be held at Families and Youth, Inc., 1320 South Solano, Las Cruces. Click here for a map.
Please RSVP by November 4: call (505) 816-4316 or 800-835-8699, or e-mail Christine Rocha.
Value-added benefits BlueSalud provides the following value-added benefits in addition to the standard benefits offered through the State of New Mexico’s Medicaid Managed Care Program:
BlueSalud members who are eligible for Medicaid category 035 (Medical Assistance for Pregnancy-Related Services Only) can receive full BlueSalud benefits, including vision, dental, and transportation services.
Infant car seats for pregnancy members who receive prenatal care and enroll in our Special Beginnings Program
Adult routine physicals
Special Beginnings Program
Blue Care Advisors
Blue Access for Members
Tobacco Cessation Program
Weight Management Program
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.
A Division of Health Care Service Corporation, a Mutual Legal Reserve Company, an Independent Licensee of the Blue Cross and Blue Shield Association.
