- 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 Blue Cross and Blue Shield of New Mexico (BCBSNM's) Medical Policies, please call the Office of the Medical Director at (505) 816-2093. Effective Date | Policy # | Policy Name | 08/15/12 | MED208.004 | Genetic Testing for Inherited Susceptibility to Colon Cancer Including Microsatellite Instability | 08/15/12 | SUR702.016 | Intravenous Anesthetics for the Treatment of Chronic Pain | 08/15/12 | SUR713.032 | Viscocanalostomy and Canaloplasty | 08/15/12 | SUR713.033 | Transciliary Fistulization for the Treatment of Glaucoma | 08/15/12 | SUR713.034 | Aqueous Shunts for Glaucoma | 08/15/12 | SUR714.008 | Semi-Implantable and Fully Implantable Middle Ear Hearing Aid for Moderate to Severe Sensorineural Hearing Loss | AIM introduces new online application enhancements
AIM Specialty HealthSM (AIM®) administers the BCBCNM's Radiology Quality Initiative (RQI) program. Obtaining an RQI number through AIM is required by BCBSNM prior to ordering high-tech, outpatient, nonemergency imaging services (MRI/MRA, CT/CTA, Nuclear Cardiology, and PET scans) for most BCBSNM members.
View full story 15,000 eCards for HealthSM delivered to date
In September 2009, BCBSNM launched the eCards for Health website at ecardsforhealth.com. This site features free online greeting cards designed to encourage people to commit to small healthy changes and share their commitments with loved ones and friends. As of March 2012, ecardsforhealth.com has received more than 100,000 hits and 15,000 eCards have been sent by visitors who have accessed the site. The most popular eCards are “Sweet Treats,” “Sole Mates,” “Texting and Driving” and “Healthy Dining.” Two new eCards have been added to the collection—“Kids and Nutrition,” which focuses on childhood obesity, and “The Silent Killer,” which focuses on high blood pressure. Recipients also receive healthy tips and links to more wellness information. Encourage your patients to view our complimentary online greeting card collection at ecardsforhealth.com. These programs are for informational purposes only, and are not a substitute for the sound medical judgment of a doctor. Members are encouraged to talk to their doctor if they have any questions or concerns regarding their health. In the Know: Online training supports improved immunization services
PROTECTcme.org is a collaborative educational curriculum with the mission of improving clinician performance and patient health associated with immunizations across the age spectrum.
View full story “Got Shots? Protect Tots!” event planned for August 4-18
The New Mexico Department of Health, the New Mexico Primary Care Association (NMPCA), and the New Mexico Immunization Coalition (NMIC) will again host a “Got Shots?” event. The sponsors would like providers to open their doors on one or more days from August 4 to 18, preferably during evening or weekend hours, to see any child who presents for immunizations without an appointment, regardless of whether he or she is a current patient or has insurance.
View full story Provider education webinars available
BCBSNM offers complimentary educational webinar sessions for our provider community and their staff. Some of the current training modules are: - ICD-10
- Availity®
- BlueCard®
- Clear Claim Connection
- Electronic Commerce
- Interactive Voice Response (IVR)
- iEXCHANGE®
- Refund and Recoupment
- Provider Website tour
Visit our Provider Training page at bcbsnm.com for more information and to register. If you have questions, please email us. Add ‘eRM’ to your electronic toolkit
Our Electronic Refund Management (eRM) tool is designed to help make the Payment Recovery Program (PRP) overpayment reconciliation process easier for you. The PRP enables BCBSNM to recoup overpayments made to BCBSNM contracting facilities and providers when payment errors occur.
View full story 2012 Drug List Updates Get Smart: Antibiotic Use
Antibiotic resistance is a growing public health problem worldwide. The Centers for Disease Control and Prevention has published treatment guidelines for upper respiratory tract infections in both children and adults. For more information, please see
http://www.cdc.gov/getsmart/specific-groups/hcp/outpatient.html Lovelace Westside Hospital Opens Inpatient Pediatric Unit
The Inpatient Pediatric Unit at Lovelace Westside Hospital is open, serving children on Albuquerque's Westside and in Rio Rancho. This is the first pediatric unit on Albuquerque's Westside and in Rio Rancho. 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 Troubleshooting error messages on ANSI v5010 professional claims
If you are submitting electronic professional claims in the ANSI Version 5010 format, please review the table below for examples of reject “R” messages you may receive when claims are submitted incorrectly to BCBSNM. As a reminder, all rejected claims must be corrected and resubmitted electronically. If you use a billing service or clearinghouse to transmit claims on your behalf, please make them aware of the information below. Any questions regarding this notification may be directed to our Electronic Commerce Center at 800-746-4614. Error Number/Message | Resolution | 0x3938c89
Ordering Provider Name should not be used. | - Loop 2420A: If the rendering and ordering providers are the same, only transmit information in the Rendering Provider name.
- Loop 2420E: The ordering provider name should only be sent when it is different than that of the Rendering Provider Name (Loop 2420A).
| 0x3938c58
Rendering Provider Name is required at the claim level when it is the same for every service line. | - Loop 2310B: The Rendering Provider Name (Loop 2420A) is required at the service line when it is different from that at the claim level (2310B).
| 0x3938c5f
Referring Provider Name should be used at claim level. | - Loop 2310A: The Referring Provider Name (Loop 2420F) is required at the service line when it is different from that at the claim level (2310A).
| Predetermination request reminders
A predetermination of benefits is a voluntary, written request for review of treatment or services, including those that may be considered experimental, investigational or cosmetic.* Prior to submitting a predetermination of benefits request, you should always check eligibility and benefits first to determine any preservice requirements. A predetermination of benefits is not a substitute for the preauthorization process.
View full story Process reminders for self-administered drugs
For those medications that are self-administered, BCBSNM members are required to use their pharmacy benefit and acquire the medication through a pharmacy provider. Self-administered drugs can include oral, patch, and injectable products.
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). 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. Provider Disclosure form now available for BlueSalud providers
Upon application, renewal, or at any time on request, federal regulation requires BlueSalud providers to complete, sign, and return the Provider Disclosure form regarding certain criminal convictions, ownership and control information.
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. | 