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April 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

Provider education webinars available
Blue Cross and Blue Shield of New Mexico (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)
  • Refund and Recoupment
  • Provider Website tour

Visit our Provider Training page for more information and to register. If you have questions, please email us.

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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Medicare Part D Drug News Update: FDA issues new dosing recommendations for all zolpidem-containing products

Self-administered Specialty Drug Update (Hemophilia, Hepatitis C and Multiple Sclerosis) In last month’s Blue Review, we included a reminder that BCBSNM members are required to use their pharmacy benefit for U.S. FDA-approved self-administered drugs (oral, topical, and injectable) and obtain these medications through a pharmacy provider. Self-administered drugs should not be submitted on professional/ancillary electronic (ANSI 837P) or paper (CMS-1500) claims.
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Getting ready for ICD-10: Is your technology on track?
The transition to ICD-10 requires everyone in the health care industry to assess his or her technology and ensure he or she has technical systems capable of utilizing ICD-10 codes. The U.S. Department of Health and Human Services (HHS) has mandated that everyone covered by the Health Insurance Portability and Accountability Act (HIPAA) must transition from ICD-9 code sets and adopt ICD-10-CM diagnosis codes and ICD-10-PCS procedure codes on Oct. 1, 2014.
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April is Alcohol Awareness Month
Your patients may not be aware that alcohol is the most commonly used addictive substance in the United States. One in every 12 adults—17.6 million people—suffer from alcohol abuse or dependence, according to the National Council on Alcoholism and Drug Dependence, which promotes Alcohol Awareness Month on its website at  ncadd.org.
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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

Annual procedure code update
On Jan. 1, 2013, the Centers for Medicare & Medicaid Services (CMS), in conjunction with the American Medical Association (AMA) and the American Psychiatric Association (APA), issued major changes to CPT and HCPCS procedure codes. BCBSNM implemented these additions, deletions, and revisions, including the multiple changes to the behavioral health codes, effective Jan. 1, 2013. The new codes are based on the date of service, not the date the claim was submitted. Please note that the retired codes will not be accepted for payment for service dates on or after Jan. 1, 2013. For more information, visit the AMA website at ama-assn.org, or the APA website at psychiatry.org/practice.

Reimbursement for interpreter services
Some patients may need an interpreter while visiting your office. Contracted providers will need to provide an interpreter for limited English proficient individuals and interpretative services for patients who qualify under the Americans with Disabilities Act (ADA).  Providers can arrange for the service using an interpreter service of their choice. Once the service is provided, the provider may submit an invoice for reimbursement to:

Provider Servicing
1205 N. Loop 340
Lacy-Lakeview, TX 76705

Are you using the correct forms?
We periodically update the forms in the provider section of our 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.
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Submitting electronic replacement claims reminder
Electronically submitted replacement claims (also referred to as “corrected claims”) can reduce the possibility that a claim will deny as a duplicate. The BCBSNM claim system recognizes claim frequency codes on professional electronic claims. You can submit the appropriate electronic replacement code to indicate that the claim is an adjustment to a previously adjudicated electronic claim. Because the new claim will completely replace the previous claim, including all necessary details is essential.

For more information on professional electronic replacement claims and other claim filing tips, refer to the Claims and Eligibility section of our Provider website at bcbsnm.com/provider.

Enhancements in claims processing efficiency
In the third quarter 2013, BCBSNM will begin accepting partial batches, rejecting only individual claims that do not meet HIPAA compliance standards.
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Providers who have joined or left the BCBSNM network, February 2013
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 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.

P.O.Box 27630, Albuquerque, NM 87125-7630

© Copyright 2013. All Rights Reserved.
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