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May 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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BlueSaludSM Drug List Updates

Medicare Part D Formulary Updates: First Quarter 2013

Behavioral Health Clinical Practice Guidelines 2013-2014
Behavioral health clinical practice guidelines (CPGs) are available on our website in the Clinical Resources/Behavioral Health section. These CPGs have been adopted by Blue Cross and Blue Shield of New Mexico (BCBSNM) and are the foundation for the Behavioral Health Care Management Programs. Updates to CPGs are reviewed and adopted annually.

The Behavioral Health Clinical Practice Guidelines address the following conditions:

  • Acute Stress Disorder and Post-traumatic Stress Disorder (PTSD)
  • Attention-Deficit/Hyperactivity Disorder (ADHD)
  • Bipolar Disorder
  • Eating Disorders
  • Major Depressive Disorder
  • Obsessive-Compulsive Disorder
  • Panic Disorder
  • Schizophrenia
  • Substance Abuse Disorders

If you have any questions about the CPGs adopted by BCBSNM, contact the Behavioral Health department, Attention: BH Quality Improvement, 1001 East Lookout Drive, Richardson, TX, 75082, or e-mail us.

Ready or not? Here comes ICD-10...
We may wish it was a game of hide-and-seek, but the transition to ICD-10 is serious business. The U.S. Department of Health and Human Services (HHS), which has mandated the transition to ICD-10, has stated that there will be no more delays and no grace period. On Oct. 1, 2014, health care entities covered by HIPAA will be required to replace ICD-9 codes with ICD-10 codes.
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The real costs of prescription coupons
The use of promotional discount cards and copayment coupons for prescriptions has tripled in the last five years, according to health research firm IMS Health*. Consumers may obtain coupons from manufacturer websites, drug ads and providers.
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Self-administered specialty drug reminder: hemophilia drugs
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 specialty drugs (oral, topical, and injectable) and obtain these medications through a pharmacy provider that is contracted to provide specialty pharmacy services. Self-administered drugs should not be submitted on professional/ancillary electronic (ANSI 837P) or paper (CMS-1500) claims.  In addition, effective July 1, 2013, the following message will be returned on the electronic payment summary or provider claim summary to providers billing for self-administered drugs, including self-administered drugs for hemophilia: “Self-administered drugs submitted by a medical professional provider are not within the member's medical benefits. These charges must be billed and submitted by a pharmacy provider.”
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Be Smart. Be Well.®: Addressing  Addictions
According to the National Institute on Drug Abuse (NIDA), more than 20 million Americans have a drug or alcohol problem. BeSmartBeWell.com features addiction as its newest topic. The site may be helpful to your patients facing addiction problems themselves, or with someone they know. Real-life stories are shared to help inspire individuals to make positive changes in their lives.
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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

National Drug Code (NDC) reminders for professional/ancillary claims
When drugs are billed under the medical benefit on professional/ancillary electronic (ANSI 837P) and paper (CMS-1500) claims, it is important to include NDCs and related data. Using NDCs on medical claims facilitates more accurate payment and better management of drug costs based on what was dispensed.
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Want to save your staff time?
Through Availity®, physicians and other health care professionals can conduct transactions at no charge. Transactions include eligibility and benefits, preauthorizations, claim status, remittance with multiple payers, and much more. Go to Availity to register for this free, time-saving tool.
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Enhancements to ClaimsXten code auditing tool
BCBSNM will enhance the ClaimsXten code auditing tool by adding the second quarter code and bundling logic into our claim processing system beginning on or after July 15, 2013.
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Providers who have joined or left the BCBSNM network, March 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

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