|January 2013 |
Please distribute this newsletter, which contains claims, billing, Medical Policy, reimbursement, and other important information, to all health care providers, administrative staff, and billing departments/entities that this email address represents.
You can find Blue Review online!
Do we have your correct information?
Maintaining up-to-date contact and practice information helps to ensure that you are receiving critical communications and efficient reimbursement processes. Please complete our quick and easy online form if you have:
- 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.
|Policy Name |
IBio-Engineered Skin and Soft Tissue Substitutes
Alternative Modes of Nutrition in the Outpatient and Home Setting
Varicose Vein Management
Anti-Vascular Endothelial Growth Factor
(VEGF) Inhibitors for use in the Eye
|SUR710.008 || |
Periurethral Bulking Agents for the Treatment of Urinary Incontinence
|SUR706.009 ||Sleep Related Breathing Disorders, Medical and Surgical Management |
|THE803.016 ||Manipulation Under Anesthesia |
Stem-Cell Transplant (SCT) for Treatment of Chronic Lymphocytic
Leukemia (CLL) and Small Lymphocytic Lymphoma (SLL)
Keeping your ICD-10 conversion on track
The ICD-10 conversion is a significant undertaking for small and large practices alike. Without a focused and clear plan, some providers may run the risk of missing the U.S. Department of Health and Human Service’s Oct. 1, 2014, deadline, which could lead to delays in claims payments. The ability of multiple business teams, including but not limited to the Information Technology (IT) team, to manage the threat of “scope creep” is crucial to converting to ICD-10 on time and within budget.
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Blue Medicare Rx Medicare Part D Formulary changes 2012 to 2013
Medicare Part D News Update: Ranbaxy Pharmaceuticals Atorvastatin Recall
Provider education webinars available
BCBSNM offers complimentary educational webinar sessions for our provider community and their staff. Some of the current training modules are:
- Clear Claim Connection
- Electronic Commerce
- Electronic Refund Management (eRM)
- Interactive Voice Response (IVR)
- Refund and Recoupment
- Provider website tour
Visit our Provider Training page for more information and to register. If you have questions, please email us.
Provider One Call available soon!
In an effort to further assist you, our partners, in the care of our members, this fall we designed a pilot entitled “Provider One Call” and due to its success, we are now expanding this service to all our providers. We now have a toll-free line (1-855-610-9833) that will go statewide on January 14, 2013. This line is meant to expedite referrals for our providers who may be experiencing some difficulty finding a referral source within our network, or want to identify a behavioral health referral for a client.
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Lovelace Women's Hospital now offers DIEP flap reconstruction
Lovelace Women's Hospital has just added deep inferior epigastric perforators (DIEP) flap reconstruction to the array of procedures available to breast cancer patients in New Mexico. Now women have more options for their reconstructive surgery after mastectomy.
The DIEP flap uses fat and skin from the abdominal wall to form a new breast. The tissue is cut free from the donor site and moved to the chest where microsurgery is used to re-connect the tiny vessels for circulation. The DIEP flap spares the abdominal muscles, which results in less pain during recovery, less muscle weakness in the abdominal area and a lower risk of hernias in the future.
The procedure is being performed by Jennifer Chan, M.D., from Sandia Plastic Surgery and Gladys S. Tsao-Wu, M.D., from New Mexico Plastic Surgeons.
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
Preventive colonoscopies: updated FAQs and article clarification
In September 2012, we published a Blue Review article titled,“Processing claims for preventive colonoscopies now automated.” This article included five frequently asked questions (FAQs) about colorectal cancer screening via colonoscopy. In response to additional provider inquiries, we’ve updated these Preventive Colonoscopy Claim FAQs with answers to the following new questions:
- When a colonoscopy is performed to follow up on a previously identified abnormality, is it covered as a preventive service with no patient cost-share under the health care reform law?
- How often can a patient be screened for colorectal cancer using colonoscopy without patient cost-sharing under health care reform?
Previous article clarification
The September article stated, “ACA requires that preventive services such as diagnostic colonoscopy, be covered without member cost sharing when the member is covered by a non-grandfathered health care plan.” The article also stated, “Accurate claims billing is essential to receiving correct payment for a preventive care service like a diagnostic colonoscopy.” Please note that the term “diagnostic colonoscopy” in these sentences refers to colorectal cancer screening using colonoscopy.
Using National Drug Codes (NDCs) on professional/ancillary claims CPT copyright 2010 American Medical Association (AMA). All rights reserved. CPT is a registered trademark of the AMA.
Currently, BCBSNM requires inclusion of National Drug Codes (NDCs) and related NDC data (qualifier, unit of measure, number of units, and price per unit), along with the applicable HCPCS or CPT code(s) on claim submissions.
Changes are on the horizon in 2013 and including NDC data on claims will play a significant role. If you don’t already, please begin including NDCs and related data when drugs are billed under the medical benefit on professional electronic (837P) and paper (CMS-1500) claims.
For additional information to assist you with using NDCs on electronic (837P) and paper (CMS-1500) claims, please refer to the Provider Reference Manual, Section 5 – Professional Provider Reimbursement. Also watch the News and Updates section of our Provider website for NDC announcements, key dates and related resources.
Providers who have joined or left the BCBSNM network, November 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
Requirements for Home Health Agencies participating in the New Mexico Medicaid program
Section 6407 of the Affordable Care Act requires that physicians document the existence of a face-to-face encounter (including through the use of Telehealth) for certification of eligibility for home health services with a Medicaid-eligible individual prior to ordering the provision of the services.
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BlueSalud services are funded in part under contract with the State of New Mexico.
Blue Medicare Advantage (HMO)SM
Provider Medicare Marketing Guidelines
Did you know that all providers who contract with BCBSNM to provide Medicare Advantage services are expected to abide by the Centers for Medicare & Medicaid Services (CMS) rules for marketing when it involves BCBSNM or Blue Medicare Advantage (HMO)SM products or benefits?
View the guidelines that are applicable to providers in the Provider Medicare Marketing Guidelines Excerpt located on the Network Participation/Medicare section of our website.
If you have questions about these guidelines or are planning marketing activities, please contact John Vargas, Provider Network Representative, at 505-816-2059 or
HCSC is a Medicare Advantage organization with a Medicare contract.
Ideas for articles and letters to the editor are welcome; e-mail NM_Blue_Review_Editor@bcbsnm.com
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