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July 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
Keep up-to-date with the latest news and updates!
Along with all the valuable information included in our Blue Review newsletter, the News and Updates section of our website gives the latest updates in webinar schedules, current programs, and policies.
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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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Don’t procrastinate – get ready for ICD-10
According to the American Health Information Management Association’s (AHIMA) most recent survey, the average cost budgeted by providers to train one ICD-10 coder is $12,000.1 What is your training budget? Do you know how much your practice needs to budget for ICD-10 training?
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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 include the following:

  • 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.

Webinars still available for behavioral health providers
BCBSNM is excited to offer complimentary online training sessions customized for our behavioral health providers and their support staff. These webinars will demonstrate electronic transactions that can be conducted, at no cost to you, via the Availity Web portal. Multiple sessions will be offered in July for your convenience.
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GuidedHealth® platform supports clinical program expansion
BCBSNM offers a wide range of clinical programs to help enhance the level of care and outcomes for our members. As an enhancement in 2013, we’re pleased to announce the implementation of GuidedHealth. This analytics platform from Prime Therapeutics (Prime) integrates medical and pharmacy claims data, applies evidence-based clinical rules, and provides medication-related recommendations to physicians and members.
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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

Important change for claim status requests  
Please be aware that starting Aug. 1, 2013, claim status will be offered exclusively through the BCBSNM automated phone system and electronic vendors, such as Availity. We understand your need to speak with someone at times to resolve specific patient inquiries; therefore, our Customer Advocates will remain available for eligibility and benefit inquiries as well as claim adjustments when necessary.
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Navigating the BCBSNM Interactive Voice Response (IVR) phone system
Our automated IVR system enables you to conduct business with BCBSNM quickly and efficiently without the need to speak to a Customer Advocate. If you prefer to use the telephone rather than go online, you can use the automated IVR system to obtain eligibility and benefits information, check claim status, and initiate select inpatient and outpatient preauthorization requests. The information you receive through our IVR is just as reliable as the information offered by Customer Advocates—without the need to wait on hold.

Easy-to-follow, detailed instructions for navigating our IVR phone system are available on our website at bcbsnm.com/provider in the Claims & Eligibility section. Our IVR Calling Guides offer step-by-step instructions for the following:

  • Eligibility and Benefits
  • Inpatient Preauthorization
  • Outpatient Preauthorization
  • Preauthorization: Check Request Status
  • Preauthorization: Extend a Request
  • Behavioral Health Eligibility and Benefits
  • Behavioral Health Preauthorization
  • Claim Status

Claim letters get a new look
BCBSNM is continually working to improve the customer experience. We know that members—as well as health care providers—need information that is easy to understand. That’s why we recently updated the format, tone, and readability of many of our standard claim letters.
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Providers who have joined or left the BCBSNM network, May 2013
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.

“Got Shots? Protect Tots!” event planned for August 3–17
The New Mexico Department of Health, the New Mexico Primary Care Association (NMPCA), and the New Mexico Immunization Coalition (NMIC) will again host a “Got Shots?” event. Sponsors would like providers to open their doors on one or more days from August 3 to 17, preferably during evening or weekend hours, to see any child who presents for immunizations without an appointment, regardless of whether he or she is a current patient or has insurance.
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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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