- 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 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. Effective Date | Policy # | Policy Name | 11/15/12 | RX501.071 | Plerixafor Injection (Mozobil) | 11/15/12 | SUR702.005 | Acupuncture | 11/15/12 | RAD601.050 | Intraoperative Radiation Therapy (IORT) | 12/01/12 | MED201.013 | Prolotherapy | 12/01/12 | MED208.025 | Kinesin-like protein 6 (KIF6) Genotyping for Predicting Cardiovascular Risk and/or Effectiveness of Statin Therapy | | Call for hospital volunteers for ICD-10 discussion
Blue Cross and Blue Shield of New Mexico (BCBSNM) is planning a panel discussion to review the successes and challenges that Hospital Information Management (HIM) staff have encountered as they plan for the transition to the ICD-10 code set. We are looking for HIM executives to share their ICD-10 experiences to date in this panel discussion that will be open to all providers. We are tentatively scheduling this for the first quarter of 2013, with specific dates and times to follow. We are seeking hospital staff volunteers to participate in this important discussion. If you would like to join us on the panel, please submit your name and contact information, along with your organization’s name, to icd@bcbsnm.com. Provider education webinars available
BCBSNM offers complimentary educational webinar sessions for our provider community and their staff. Some of the current training modules are: - Availity
- BlueCard
- Clear Claim Connection
- Electronic Commerce
- ICD-10
- Interactive Voice Response (IVR)
- iEXCHANGE
- Refund and Recoupment
- Provider Website tour
Visit our Provider Training page for more information and to register. If you have questions, please email us. Opioid Induced Hyperalgesia Administrative Simplification: Past, Present and Future
Administrative Simplification was introduced as a component of the Health Insurance Portability and Accountability Act (HIPAA) to streamline administrative processes while increasing security of protected health information by standardizing electronic health care transactions between HIPAA-covered entities. Covered entities include all health benefit plans, health information technology vendors, physicians, facilities, and other health care professionals.
View full story Are you sure your claims reflect your records?
In last month's Blue Review, we presented an introductory article to help you become familiar with the general background, essential elements and potential impact of Risk Adjustment on your practice.
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 Electronic Remittance Advice (ERA) enrollment process change
The ERA is a HIPAA-compliant electronic data file that can be used for automatic posting of payments to your patient accounts. The advantage of the ERA is that the payment information is received in your office the pay cycle after claim finalization. Also, when you enroll for ERA, you will automatically receive the Electronic Payment Summary (EPS)—a convenient alternative to your paper Provider Claim Summary (PCS).*
View full story Processing claims for preventive colonoscopies now automated
Processing for preventive colonoscopy claims with modifiers PT and 33 is now automated for BCBSNM. This new automated claims processing demonstrates BCBSNM's commitment to make changes to effectively implement the Affordable Care Act (ACA) Preventive Care Services provision.
View full story Providers who have joined or left the BCBSNM network, August 2012
This list reflects contracted providers for all lines of BCBSNM business: Commercial and Medicaid managed care (BlueSaludSM).
View full story 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. BlueSalud covers dental varnish performed by trained primary care providers (PCPs)
Fluoride varnish is a simple, safe, painless, and affordable compound that can be applied to children's teeth by trained PCPs. The varnish has been approved by the Federal Drug Administration for use in the United States since 1997. A number of states currently using fluoride varnish report encouraging results for childhood dental health.
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. | 