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March 2010
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.
Yearly HEDIS® visits will begin soon During the next few months, BCBSNM nurses will be visiting physician offices to gather information for the nationally validated Healthcare Effectiveness Data and Information Set (HEDIS). View full story
Medical Policy information 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. You may view all active and pending Policies or view draft Medical Policies and comment.
While information on new or revised Medical Policies is also published in this newsletter for your convenience, please visit our website for access to the most complete and up-to-date Medical Policy information. If you have any questions about BCBSNM’s Medical Policies, please call Health Services at (505) 816-2093.
There were no Medical Policy updates for this issue.
Medicare Part D pharmacy updates: Pharmacy compounding Compounding is an ancient practice in which pharmacists combine, mix, or alter ingredients to create unique medications that meet specific needs of individual patients. Compounding continues to attract the scrutiny of the U.S Food and Drug Administration (FDA) because of instances where compounded drugs have endangered public health. View full story
Tri-Lo SprintecTMunavailability Tri-Lo Sprintec, a generic oral contraceptive manufactured by Teva Pharmaceutical Industries, Ltd., may no longer be available in BCBSNM network pharmacies because Teva stopped shipping the product last year. PrimeMail® will substitute the brand version of this product, Ortho Tri-Cyclen® Lo, when the supply of the Tri-Lo Sprintec runs out, and will notify members of this change with the shipment of their orders. Both Ortho Tri-Cyclen Lo and Tri-Lo Sprintec contain the exact same progesterone and estrogen components at the same strengths.
Prime will also notify retail network pharmacies to substitute the brand version of the product if they can no longer obtain Tri-Lo Sprintec. With the unavailability of the generic version, Ortho Tri-Cyclen Lo will remain at formulary brand or preferred brand status with the applicable copay amount.
Have an idea for an article? We want to hear from you! Let us know if Blue Review continues to meet your standards. Does this publication address your needs? What topics would you like to read about? BCBSNM’s success is dependent on your business as a contracting provider. Blue Review was created to communicate tools, updates, and tips to support your health care practice. Think of Blue Review as a canvas for your BCBSNM business information.
We invite you to submit your feedback and suggestions for improvements via e-mail. Thank you.
New Be Smart. Be Well.®topic launches Visit Be Smart. Be Well. today to find information about health and wellness issues, such as sexually transmitted disease (STD), the latest topic to be added to the Be Smart. Be Well. library.
Each topic features videos combining information from subject-matter experts with the very personal stories of those who have been affected. With the STD topic, you’ll meet Molly, who never thought herpes could happen to her, and Ida, who lives with HIV.
The easy-to-follow “Habits to Have” section offers tips that may help your patients on the road to making smarter, healthier choices. Visit besmartbewell.com today and encourage your patients to do the same.
About Be Smart. Be Well. The goal of Be Smart. Be Well. is simple: help all of us stay healthier and safer through increased awareness and simple-to-use knowledge. Additional topics posted at besmartbewell.com include: Childhood obesity, managing pregnancy risk, traumatic brain injury (TBI), caregiving, drug safety, and mental health, with domestic violence coming soon.
2010 changes affect claims filing for Walmart® associates Effective January 1, 2010, changes will alter the way you file claims for Walmart associates. BlueAdvantage® Administrators of Arkansas will be the third-party administrator for all Walmart associates nationwide, including those previously administered by Blue Cross and Blue Shield of New Mexico (BCBSNM). View full story
Stay informed with electronic commerce alerts Does your office submit claims electronically or receive claim payments via electronic funds transfer (EFT)? Are you enrolled in electronic remittance advice (ERA) and/or electronic payment summary (EPS)? If you conduct business electronically with BCBSNM, it is important to become a regular visitor to our Electronic Commerce Alerts Web page. View full story
Getting started with our electronic commerce tools If you are one of the growing number of BCBSNM providers who have signed up for electronic funds transfer (EFT), electronic remittance advice (ERA), and electronic payment summary (EPS), thank you for using these electronic transactions! If your office has not yet enrolled for EFT, ERA, and EPS, we encourage you to explore these time- and money-saving options.
We have a variety of online e-commerce resources available to help you feel confident and informed. Visit our Advantages of Electronic Commerce page, where you will find our EFT and ERA enrollment forms, an electronic options tutorial, answers to frequently asked questions (FAQs), and more.
Electronic payment summary (EPS) formatting tips The EPS is delivered by BCBSNM as a text file so that you can receive it in conjunction with your electronic remittance advice (ERA).* The EPS contains the same information as the paper Provider Claim Summary (PCS). You can save the EPS as an electronic file for future retrieval, or you may choose to select and print some or all of the document.
Use these formatting tips for proper viewing upon downloading your EPS to help ensure that it looks like the PCS:
Open the document in your word-processing application.
Set the page layout as landscape, not portrait.
Select Courier New for the font style.
Select 8 point for the font size.
*Note: If you are using a billing agent, the EPS goes to the receiver, vendor, or clearinghouse. Delivery or posting specifications are determined by the vendor, not BCBSNM. Therefore, you should check with your receiver, vendor, or clearinghouse to determine if you will need special software to view the EPS file.
BlueSaludSM Important information for Medicaid hospitals using State of New Mexico DRG weights BCBSNM will implement the new State of New Mexico Diagnosis-Related Group (DRG) Weight Table (version 27) on March 1, 2010, to process inpatient claims under our Medicaid line of business. No new DRGs were added to version 27 by the Centers for Medicare & Medicaid Services (CMS). We would be happy to provide a copy of the updated list of DRGs and weights upon request; please contact Angela Sanchez-Caldwell at (505) 816-2038 or via e-mail.
Vaccines for Children program A federal program called Vaccines for Children (VFC) provides free vaccines to eligible children, including those without health insurance coverage, including all those who are enrolled in Medicaid; American Indians; and Alaskan Natives. The State of New Mexico provides additional funding to purchase vaccines for all VFC-non-eligible children so that all New Mexico children from birth to 18 years old can receive free vaccines.
Providers may participate in the VFC program without participating in Medicaid if they are qualified to administer vaccines under applicable State law. However, such providers will not be reimbursed by Medicaid for their services in administering vaccines.
Under the VFC program, a provider may impose a fee for the administration of a qualified pediatric vaccine if the fee, in the case of a federally vaccine-eligible child, does not exceed the cost of such administration (as determined by the Secretary based on actual regional costs for such administration). However, a provider may not deny administration of a qualified pediatric vaccine to a vaccine-eligible child due to the inability of the child’s parents or legal guardian to pay the administration fee.
BCBSNM will reimburse VFC-participating providers for vaccine administration, depending on your contracted reimbursement rate with BlueSalud. We encourage all contracted BCBSNM providers to participate so that all New Mexico children from birth to 18 years old receive the necessary vaccines to prevent vaccine-preventable diseases. If you have any questions about reimbursement for vaccines, please call Angela Sanchez-Caldwell at (505) 816-2038.
Not yet contracted for BlueSalud? Providers who are participating in commercial BCBSNM products are not automatically participating providers in BlueSalud. To become a BlueSalud provider, you must sign a Medicaid amendment to your Medical Services Entity Agreement (MSEA). Please contact Angela Sanchez-Caldwell at (505) 816-2038 or by e-mail if you are interested in becoming a BlueSalud provider.
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.
