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February 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!

Ideas for articles and letters to the editor are welcome; e-mail NM_Blue_Review_Editor@bcbsnm.com

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
  • 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.
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ICD-10 will change everything
Will you be ready to make the change to ICD-10? Blue Cross and Blue Shield of New Mexico (BCBSNM) has a variety of resources to assist you with your transition plans.

We've posted a new ICD-10 Provider Office Changes Map
to help show how ICD-10 will change everything from your front desk to your clinical areas:
  • Your front desk may need to have revised privacy policies.
  • Your lab may have to meet new reporting requirements.
  • Physicians will require training as codes increase from 17,000 under ICD-9 to 140,000 under ICD-10.

Visit the ICD-10 page in the provider section of our website for related resources such as FAQs, webinars, and our Readiness Survey.


Annual HEDIS® Project Begins February 2013

During the next few months, BCBSNM nurses will be contacting your office or facility in preparation for the gathering of information for the nationally validated Healthcare Effectiveness Data and Information Set (HEDIS).
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Be Smart. Be Well.® Encourages Sexual Health
Be Smart. Be Well. is the BCBSNM website that features a variety of health and wellness topics and is available to members and the general public at BeSmartBeWell.com. The current spotlight topic, sexual health, features a new video, produced as part of a public/private collaboration between Be Smart. Be Well. and the Centers for Disease Control and Prevention (CDC).

While many patients are comfortable talking with their physicians about their aches and pains, talking to them about sexual health may be a different matter. The Be Smart. Be Well. sexual health series is a great way to introduce this subject to patients and encourage:

  • Frank discussions about sexual health
  • Testing for sexually transmitted diseases

Be Smart. Be Well. is a valuable tool for anyone interested in learning about making healthy lifestyle choices. Past topics have included food safety, traumatic brain injuries, teen driving, caregiving, childhood asthma, drug safety, and domestic violence. Please encourage your patients to take advantage of the information and resources on BeSmartBeWell.com.

These programs are for informational purposes only, and are not a substitute for the sound medical judgment of a health care professional. Members are encouraged to talk to their doctor if they have any questions or concerns regarding their health.

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

Providers with Multiple Specialties
If you have obtained a unique Organization (Type 2) NPI number for each specialty, you should bill with the appropriate Individual (Type 1) and Organization (Type 2) NPI number combination accordingly.

In the absence of a unique Organization (Type 2) NPI number for each specialty, you are strongly encouraged to include the applicable taxonomy code* in your claims submission. Taxonomy codes play a critical role in the claims payment process for providers practicing in more than one specialty. Electronic claims transactions accommodate the entry of taxonomy codes and will assist BCBSNM in selecting the appropriate provider record during the claims adjudication process. For assistance in billing the taxonomy code in claim transactions, refer to your practice management software and/or clearinghouse guides.

*The health care provider taxonomy code set is a comprehensive listing of unique 10-character alphanumeric codes. The code set is structured into three levels—provider type, classification, and area of specialization—to enable individual, group, or institutional providers to clearly identify their specialty category or categories in HIPAA transactions. The entire code set can be found on the Washington Publishing Company (WPC) website, at http://www.wpc-edi.com/codes/taxonomy. The health care provider taxonomy code set levels are organized to allow for drilling down to a provider’s most specific level of specialization.

Administrative Simplification operating rules update
Administrative Simplification is a provision of the Affordable Care Act (ACA). Under ACA, new operating rules for HIPAA-standard transactions must be implemented to promote greater uniformity in the delivery of electronic health care data from health plans to providers. Software vendors and any other electronic business entity that provides transaction-related services, such as billing services and third party administrators, are also affected.
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Providers who have joined or left the BCBSNM network, December 2012
This list reflects contracted providers for all lines of BCBSNM business: Commercial and Medicaid managed care (BlueSaludSM).
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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 services are funded in part under contract with the State of New Mexico.


 



A Division of Health Care Service Corporation, a Mutual Legal Reserve Company,
an Independent Licensee of the Blue Cross and Blue Shield Association.



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