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February 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
Coverage for mammogram and cervical cancer screenings Although there has been a great deal of dialogue about the new proposed mammogram and cervical cancer guidelines, BCBSNM will continue to provide medical coverage for routine mammograms and cervical cancer screenings for women as ordered by their physicians and outlined in the member’s Benefit Booklet.
BCBSNM regularly monitors research to ensure that our Medical Policies are current. We will provide updates as necessary; however, medical coverage for mammograms and cervical cancer screenings remains unchanged at this time.
Care Comparison® Tool offers data transparency In September 2009, we unveiled a new online Care Comparison Tool that allows our members to review costs for specific procedures performed at hospitals, ambulatory surgery centers, and free-standing radiology centers in the BCBSNM provider network. Members can also review the volume of services performed by each facility and obtain other information based on factors most important to them. View full story
Office Staff Reminder: Modifier 50 guidelines for professional claims Modifier 50 is used to report bilateral procedures that are performed during the same operative session. The use of modifier 50 is applicable only to services and/or procedures performed on identical anatomic sites, aspects, or organs. This modifier can be used for diagnostic, radiology, and surgical procedures.
Modifier 50 should not be used when the code descriptor indicates unilateral or bilateral and should not be used when right and left would be applicable to the services. If a bilateral procedure is eligible for bilateral reimbursement, enter the bilateral procedure code with modifier 50 on one line with one unit of service.
Updated! Helpful tips for preventing claim delays We have updated our Helpful Tips for Preventing Claim Delaysto bring you more time- and money-saving tips for submitting claims to BCBSNM. You may also find these tips in theClaim Filingsection of our website.
BlueSaludSM New fax number for BlueSalud Utilization Management (UM) BCBSNM has changed the BlueSalud fax number for its Utilization Management and Case Management Programs and preauthorization requests. The new fax number is (505) 816-3854. Please fax case management information and/or preauthorization requests to the attention of Utilization Management. The new number is for BlueSalud business only.
We have also changed the phone and fax numbers for our Condition Management/Disease Management programs. The new Condition Management/Disease Management phone number is 1-866-874-0912; the new fax is (505) 816-3858.
Utilization Management (UM) Phone and Fax Numbers
Preauthorization and out-of-network referrals phone
1-888-349-3706
Preauthorization fax
(505) 816-3854
Case Management programs phone
1-888-349-3706
Case Management programs fax
(505) 816-3854
Condition Management programs phone
1-866-874-0912
Condition Management programs fax
(505) 816-3858
Utilization Management member appeals phone
1-877-232-5520
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.
