| May 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 information, please complete our quick and easy online form. Maintaining up-to-date contact and practice information helps to ensure that you are receiving critical communications and efficient reimbursement processes. 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 some information on new or revised Medical Policies may occasionally be published in this newsletter for your convenience, please visit our website for access to the most complete and up-to-date information. For example, due to time constraints, the following list of new or revised policies may not be complete as of the date of publication. If you have any questions about BCBSNM's Medical Policies, please call the Office of the Medical Director at 505-816-2093. Effective Date | Policy # | Policy Name | 04/15/12 | THE803.019 | Cognitive Rehabilitation | 04/15/12 | DME101.044 | Noncontact Wound Therapy | 04/15/12 | RX501.069 | Erythropoiesis-Stimulating Agents (ESAs) | 04/15/12 | SUR710.020 | Extracorporeal Shock Wave Therapy in the Treatment of Peyronie's Disease | 04/15/12 | MED202.054 | Biventricular Pacing | 06/01/12 | SUR712.004 | Intervertebral Techniques to Treat Chronic Discogenic Back Pain | 06/01/12 | SUR707.003 | Automatic Implantable Cardioverter Defibrillator (AICD) | 07/01/12 | RX501.041 | Gonadotropin-Releasing Hormone (GnRH) Agonists and Antagonists | 07/01/12 | THE801.006 | Plasmapheresis (PP)/Therapeutic Plasma Exchange (TPE) | Pradaxa® prior authorization removal
The prior authorization requirement for Pradaxa (dabigatran etexilate) was removed in March 2012. Pradaxa is a blood thinner that is used to prevent clot formation in patients at risk for stroke or other heart conditions. The intent of the prior authorization program was to address safety concerns, appropriate patient selection, and dosing. Upon review of the cases received through February 2012, it has been determined that use of Pradaxa is consistent with clinical treatment and safety guidelines. In many cases, patients were started on Pradaxa treatment in the hospital and were monitored for potential adverse events and stabilized prior to discharge. As a result of the above findings, the decision was made to remove the prior authorization review and end the denial at point-of-sale for review for appropriate patient selection. A quantity limit will be maintained at point-of-sales claims processing to ensure that dosing is within FDA-approved labeling for Pradaxa. If a claim for Pradaxa is submitted with dosing above the maximum FDA-approved dose, it will deny for review. BlueExtrasSM offers program enhancements for our members
Our BlueExtras program offers Blue Cross and Blue Shield of New Mexico (BCBSNM) members significant discounts on health care products and services that support healthy lifestyles. To take advantage of these discounts, members may simply present their BCBSNM ID card to a participating provider. There are no referrals required to receive services and no claim forms to submit.
View full story Next Generation Blue Care Connection®—Innovations
As of December 30, 2011, BCBSNM implemented enhancements to the Blue Care Connection (BCC) program that play a key role in the evolution of care management. The focus of these innovations is on earlier identification and intervention, which may prevent or slow disease progression and improve member participation in their health care decisions.
View full story In the know: American Imaging Management® is now AIM Specialty HealthSM
In March 2012, American Imaging Management changed its name to AIM Specialty Health. The company will continue to use the AIM® abbreviation for its brand. The new website address for AIM is aimspecialtyhealth.com. The previous website address—americanimaging.net—will remain available for a short time. Here are a few details to assist you in accessing AIM's systems: - If you currently access AIM's online services through americanimaging.net/goweb, this Web address has changed to aimspecialtyhealth.com/goweb.
- If you currently access AIM's online services through providerportal.com, this Web address will remain the same.
- AIM's toll-free call center phone number has not been changed. If you have any questions, please contact AIM Customer Service at 800-252-2021.
AIM Specialty Health is an independent third-party vendor that is solely responsible for its products and services. BCBSNM makes no endorsement, representations or warranties regarding any products or services offered by independent third party vendors. If you have any questions about the products or services they offer, you should contact the vendor directly. Updated 2012 American Geriatrics Society (AGS) Beers Criteria Office Staff
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 Important v5010 reminders for electronic claim submitters
It is important to watch the Claims and Eligibility/Electronic Commerce Alerts section of our Provider website at bcbsnm.com/provider for news and updates related to electronic data interchange (EDI) transactions. See below for a quick summary of recently posted Electronic Commerce Alerts. If you use a billing service or clearinghouse to conduct electronic transactions on your behalf, please ensure they are aware of this information as well.
View full story Appropriate use of modifiers 76 and 91
On February 28, 2011, BCBSNM implemented ClaimsXten™, a code auditing tool developed by McKesson Information Solutions, Inc. One feature of this tool is Modifier-to-Procedure Validation editing. This feature has helped BCBSNM identify an increase in the use—and potential misuse—of modifiers 76 and 91, since the implementation of ClaimsXten.
View full story
Providers who have joined or left the BCBSNM network, March 2012 BlueSalud
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. New Mexico Human Services Department Issues Letter of Direction #43, Coding/Procedure Options for Opioid Addiction Treatment with Suboxone or buprenorphine
In March 2012, the New Mexico Human Services Department issued a Letter of Direction to standardize the billing process for Salud! and State Coverage Insurance (SCI) providers. It also clarifies the coding and procedures to be followed during the assessment, induction, and follow up maintenance phases provided for the treatment of opioid addiction using Suboxone or buprenorphine.
View full story 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. | 