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Please distribute this newsletter, which contains claims, billing, Medical Policy, and other important information, to all health care providers and administrative staff that this e-mail address represents. Thank you.
January 2010
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
Important provider information: New wellness initiatives for federal employees under the Service Benefit Plan (FEP) What are the programs? Beginning January 1, 2010, the Blue Cross and Blue Shield Service Benefit Plan (Federal Employee Program or FEP) will reward members when they complete either the adult Blue Health Assessment or a child’s BMI assessment. The intent of these programs is to encourage wellness and prevention and aim to remove barriers to care. View full story
Utilization management determinations Utilization management (UM) determinations are made by BCBSNM personnel based only on appropriateness of care, cost effectiveness, benefit provisions, and existence of coverage. Neither BCBSNM nor Mesa Mental Health “rewards” providers for decisions that result in underutilization of services.
If you have any questions about criteria for utilization management decisions, or wish to discuss a UM denial decision, please contact the Medical Director for Utilization Management, Matthew Fontana, MD, at (505) 816-2093. For behavioral health issues, contact Steve Sehr, MD, Mesa Mental Health, at (505) 816-6790.
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 all BCBSNM members, including BlueSalud.
Medicare Part D pharmacy updates: Results of the ARBITER 6-HALTS trial In November 2009, The New England Journal of Medicine released results of the ARBITER 6-HALTS comparative-effectiveness trial. The authors concluded that combining chronic statin monotherapy with a treatment (i.e., extended-release niacin [NIASPAN®]) intended to raise high-density lipoprotein cholesterol (HDL-C) is more effective at reducing carotid intima-media thickness (IMT) than an adjunctive therapy (ezetimibe [ZETIA®]) used to further lower low-density lipoprotein cholesterol (LDL-C). View full story
BCBSNM unveils new public website It’s important to help our members and consumers understand health insurance and find a plan to meet their needs. Our bcbsnm.com redesign, launched in early December, focuses on providing this guidance. View full story
HCSC wins high honors for corporate integrity Health Care Service Corporation (HCSC), of which BCBSNM is a Division, recently won its ninth straight Compliance Best Practice Award from the Health Ethics Trust (HET) for its commitment to compliance and ethics.
“This award signifies that we have the right culture and programs in place to help ensure we can be trusted to handle the health coverage needs of millions of members, which is essential to all health insurers,” says Pat Hemingway Hall, President and Chief Executive Officer of HCSC. “It also shows that while change in the current environment is inevitable, our commitment to integrity remains constant.”
Blue Medicare PPOSM Transition Updates Reminder: Blue Medicare PPO claims submission requirements As you know, BCBSNM exited the Medicare Advantage Program effective January 1, 2010. To ensure that providers’ claims are processed appropriately, we are providing this reminder. View full story
BlueSaludSM New Medicaid fee schedule effective December 15, 2009 On November 19, 2009, the Director of the Medical Assistance Division of the New Mexico Human Services Department issued a Medical Assistance Program Manual Supplement (Notice) requiring Medicaid Managed Care Organizations contracted for the SALUD!, Behavioral Health Statewide Entity (BH SE), Coordination of Long-Term Services (CoLTS), and State Coverage Insurance (SCI) programs, including BCBSNM, to reduce reimbursement levels. View full story
BlueSalud to reimburse providers for entering vaccine data into NMSIIS effective January 1, 2010 The New Mexico Statewide Immunization Information System (NMSIIS, pronounced “nemesis”) is an Internet database that records and tracks immunization dates for children and adults in New Mexico. NMSIIS gives practitioners, school nurses, parents, and others a tool to further improve immunization rates; helps keep New Mexicans on track for recommended immunizations; and makes vaccine records more available to all. 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.
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.
