- Moved to another location
- Left a group practice
- Changed your phone number
- Changed your e-mail address
- 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 are 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.
Alternative Modes of Nutrition in the Outpatient and Home Setting
Varicose Vein Management
Keep up-to-date with the latest news and updates!
Along with all the valuable information included in our Blue Review newsletter, the News and Updates section of our website gives the latest updates in webinar schedules, current programs, and policies.
The eCommerce Alerts section provides notification of system enhancements, upgrades, new functionality, and any Electronic Data Interchange (EDI) transaction issues that may affect claims processing, payment, or remittance delivery.
We periodically update the forms on our provider website, so it's important to check often to help ensure you are using the most current version. Forms are organized by category in our Education and Reference section.
Be sure to visit us online at bcbsnm.com/provider to access the most updated information.
Contracted laboratories with BCBSNM
Clinical and/or pathology laboratory procedures performed in a provider’s office for Blue Cross and Blue Shield of New Mexico (BCBSNM) members should be billed to BCBSNM. Always refer lab specimens to a BCBSNM in-network (aka: contracted or participating) lab when applicable. The lab performing the testing will bill for the resulting charges.
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Flu Season is Here
BCBSNM would like to remind you to encourage your patients to get their annual flu shot. (In the U.S., the flu season can start as early as October and can last as late as May.)
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Prescription Drug Monitoring Programs
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
Real-time processing for out-of-area electronic claims
BlueCard®, the national program that enables members of one Blue Cross and Blue Shield (BCBS) Plan to obtain health care services while traveling or living in another BCBS Plan's service area, just got better.
As of Oct. 15, 2012, all BlueCard claims submitted to BCBSNM are now being processed and transmitted in real-time between BCBS Plans. This enhancement will help improve processing across the Blues system by decreasing overall claim cycle times and improving the payment timeframe.
General Tips for Using Modifier 24
The Current Procedural Terminology (CPT®) defines modifier 24, as follows: “The physician may need to indicate that an evaluation and management service was performed during a postoperative period for a reason(s) unrelated to the original procedure. This circumstance may be reported by adding the modifier 24 to the appropriate level of E/M service.”
This modifier is to be used with Evaluation and Management (E/M) procedure codes only.
When the patient presents during the postoperative period (which could be 10 or 90 days from the original procedure), with an unrelated problem, it is appropriate to report the E/M service with modifier 24.
CPT copyright 2010 American Medical Association (AMA). All rights reserved. CPT is a registered trademark of the AMA.
Providers who have joined or left the BCBSNM network, September 2012
This list reflects contracted providers for all lines of BCBSNM business: Commercial and Medicaid managed care (BlueSaludSM).
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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.
BlueSalud Drug List updates
Provider Disclosure form required for BlueSalud providers
Upon application, renewal, or at any time on request, BlueSalud providers are required to complete, sign, and return the Provider Disclosure of Ownership and Control Interest Form regarding certain criminal convictions, ownership and control information.
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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.