- Moved to another location
- Left a group practice
- Changed your phone number
- Changed your e-mail address
- Retired
- Any other changes to your practice information
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 | 09/15/12 | SUR701.027 | Intracranial Stenting or Angioplasty | 09/15/12 | SUR701.028 | Extracranial Carotid Angioplasty or Stenting | 09/15/12 | RX501.040 | Growth Hormone (GH) | 09/15/12 | RAD604.010 | Lung Cancer Screening using Computed Tomography (CT), Chest Radiographs, or Serial Sputum Cytology | 09/15/12 | SUR713.001 | Refractive and Therapeutic Keratoplasty | 09/15/12 | MED201.017 | Gastrointestinal (GI) Motility Measurement | 10/01/12 | RX501.064 | Pegylated Interferon Therapy | Proposed delay offers no vacation from ICD-10
ICD-10 is a much larger undertaking than the NPI transition or ANSI 5010 conversion. The number of codes will increase from approximately 11,000 ICD-9 procedure codes to 72,000 ICD-10 procedure codes and from 13,000 ICD-9 diagnosis codes to 69,000 ICD-10 diagnosis codes. The Department of Health and Human Services (HHS) recently proposed delaying ICD-10 implementation by one year to help providers prepare to meet the challenge. An additional year of preparation might seem like a lot of time, but it’s really not.
View full story Automated preauthorization tools to be enhanced
Blue Cross and Blue Shield of New Mexico (BCBSNM) is upgrading its automated preauthorization (also known as precertification) tools. iEXCHANGE®, a Web-based application, will now support submission of preauthorization requests and receive online approval of benefits for outpatient services, in addition to continuing support of inpatient admissions. The application upgrade includes minor screen changes to the current tool.
View full story Teen Driving: Be Smart. Be Well.® Spotlight
Each year, about 3,000 teens are killed in motor-vehicle crashes, making it the leading cause of death for teens. The summer months, from Memorial Day to Labor Day, are considered the deadliest for teen drivers. And more than 350,000 teens are treated in emergency departments each year for injuries suffered in a crash*.Our newest topic on BeSmartBeWell.com, teen driving, offers safety reminders and related resources for your teen and adult patients.
View full story 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 ANSI v5010 Update: Interpreting the PLB Segment on the 835 ERA
You may have noticed changes on your electronic remittance advice (ERA) from BCBSNM, as a result of new ANSI Version 5010A1 835 requirements specified in the Technical Report Type 3 (TR3). As a reminder, the TR3 is available for purchase on the Washington Publishing Company (WPC) website at wpc-edi.com.
View full story Submitting Electronic Replacement Claims (Professional)
The BCBSNM claim system recognizes claim frequency codes on professional electronic claims (ANSI 837P transactions). Using the appropriate code will indicate that the claim is an adjustment of a previously adjudicated (approved or denied) claim.
View full story Providers who have joined or left the BCBSNM network, June 2012
This list reflects contracted providers for all lines of BCBSNM business: Commercial and Medicaid managed care (BlueSaludSM).
View full story BlueSalud
Provider Manual Change: Non-payment for HCACs and Never Events
An important update has been made to the BlueSaludSM section of the Provider Reference Manual that will impact all providers participating in the New Mexico Medicaid Program. The change reflects BCBSNM's compliance with regulations issued by the Centers for Medicare & Medicaid Services, under Section 2702 of the Affordable Care Act, which calls for non-payment for provider preventable conditions (PPCs) including health care-acquired conditions (HCACs) and Never Events. BCBSNM will not pay claims for members receiving care related to HCACs and Never Events in any healthcare setting. Providers may review the BCBSNM Blues Provider Manual on our provider website.
Vaccines for Children program
A federal program called Vaccines for Children (VFC) provides free vaccines to eligible children, including those without health insurance coverage; 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 through 18 years old can receive free vaccines.
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. | 