|March 2012 |
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. Blue Review: Share the wealth!
Each issue of Blue Review is packed with valuable information. It is very important that you share Blue Review with your billing departments/entities. Many issues contain articles relevant to department employees, such as system and coding updates, billing and reimbursement, new account groups, federal mandates, and electronic commerce solutions. You can find Blue Review online.
Do we have your correct information?
If you have moved or made other changes to your practice contact information, please complete our quick and easy online form to share your updates with us. Thank you!
Shipley assumes BCBSNM leadership with Watrin's departure
Blue Cross and Blue Shield of New Mexico President Liz Watrin announced on February 21 that she is leaving the company due to personal reasons.
Effective immediately, Kurt Shipley, BCBSNM's vice president of Programs and Network Management, will assume the leadership role on an interim basis.
Shipley is a 15-year veteran of BCBSNM. In his role as vice president of Programs and Network Management, Kurt works with all operational areas of BCBSNM and is the lead executive for the New Mexico Medical Insurance Pool, Indian Health Service/Contract Health Services, Medicaid Salud! and provider networks. With his background and experience, Kurt is well suited to ensure BCBSNM continues to provide exceptional service to customers, providers and members throughout New Mexico.
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. You may view all active and pending Policies or view draft Medical Policies and provide comments.
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 information. If you have any questions about BCBSNM’s Medical Policies, please call the Office of the Medical Director at (505) 816-2093.
Diagnosis and Treatment of Chronic Cerebrospinal Venous Insufficiency in Multiple Sclerosis
Extracorporeal Photopheresis (ECP)
Pulmonary Arterial Hypertension (PAH) Drug Therapies
|4/15/12 ||MED202.054 ||Biventricular Pacing |
On track with ACA: Affordable Care Act updates
In this monthly column, we will put the spotlight on existing and future provisions of the Affordable Care Act (ACA). The full extent of ACA becomes effective in 2014. However, there are several provisions that became effective upon enactment, such as dependent age coverage.
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Pharmacy prior authorization and step therapy requests
Effective January 1, 2012, Prime Therapeutics® (Prime) began conducting all prior authorization (PA) and step therapy (ST) requests from physicians for BCBSNM commercial members with prescription drug coverage administered by Prime. PA request forms must be submitted to Prime for all specified PA and ST medications for commercial members. Please continue to contact BCBSNM for all BlueSaludSM PA requests.
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Resolve to sign up for online transactions in 2012
With the national emphasis on health information technology, making the switch to electronic transactions is essential to help your office remain competitive. However, because BCBSNM offers and supports a broad range of electronic solutions, the choices and technology may seem overwhelming, especially for smaller provider offices. Where's the best place to begin?
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ICD-10: Preparing for the journey ahead
The federally mandated ICD-10 coding standard becomes effective October 1, 2013. This mandate requires that health care entities covered by the Health Insurance Portability and Accountability Act (HIPAA) must transition from ICD-9 code sets and adopt ICD-10-CM diagnosis codes and ICD-10-PCS procedure codes. Claims submitted for service and discharge dates prior to October 1, 2013, should be coded using the ICD-9 coding standard.
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Talking with Health Services staff
BCBSNM Health Services staff members are available to receive incoming calls, make outbound calls, and discuss care management issues with members and providers Monday through Friday, 8 a.m. to 5 p.m. MT, toll-free, at 800-325-8334. The medical director is available to address care management requests and issues at (505) 816-2093, or you may leave a message at the toll-free number above. When returning your call or otherwise calling your office or home, Health Services staff members identify themselves as BCBSNM employees and give their names and titles.
Member rights and responsibilities
Our health plan members have rights and responsibilities that are listed in their Benefit Booklet or Member Handbook. Some members—for example, members with BlueDirect® and BlueEdgeSM plans—can also find these documents in the member section of our website.
Provider Reference Manual updates
The Blues Provider Reference Manual on our website is updated throughout the year. Any updates that have occurred so far this year are located in the Table of Contents with Changes and Updates Preface page. Please note that these changes might not be current in the print and CD-ROM versions; always refer to bcbsnm.com for the most current information.
BlueCard® national account update: Online benefits now available for Central States Funds members
The BlueCard program gives a member of one Blue Cross and Blue Shield (BCBS) Plan access to another BCBS Plan's provider networks for services covered under his or her own benefit plan while traveling or living in the other BCBS Plan's service area. This out-of-area program also applies to certain national accounts.
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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.
Network Services contacts and related service areas
Network Services regional map
Lovelace Health System updates
Lovelace Westside Hospital will be opening an inpatient pediatric unit in spring 2012. The unit will have private rooms with family-friendly amenities, such as in-room sleeping accommodations for a guest and wireless Internet access. The inpatient pediatric unit will have coverage 24 hours a day, seven days week, with board-certified pediatric hospitalists from Sheridan Healthcare of New Mexico.
Lovelace Health System has completed the purchase of Roswell Regional Hospital and its Family Care Clinic in Roswell, NM. Lovelace plans to expand the hospital and add new services, equipment, technology, and staff.
Providers who have joined or left the BCBSNM network, January 2012
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 the Network Services Department at (505) 837-8800 or 800-567-8540 if you are interested in becoming a BlueSalud provider.
Ideas for articles and letters to the editor are welcome; e-mail NM_Blue_Review_Editor@bcbsnm.com.
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.