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June 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 Reference Manual updates
The Blues Provider Reference Manual on our website is updated throughout the year. Any updates that have occurred so far this year are located in the Table of Contents with Changes and Updates Preface page. Please note that these changes might not be current in the print and CD ROM versions; always refer to bcbsnm.com for the most current 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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Immunization reporting is now mandatory
In our March 2013 issue of Blue Review, we explained the importance of reporting immunizations for children and adults in New Mexico.
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Preparing our communities for health care reform
The Affordable Care Act (ACA) is transforming many facets of the health care industry. In addition to the ACA communications BCBSNM continues offering to network providers through Blue Review and through the Provider section of our website, we also offer ACA information to our members. Feel free to share any and all of these ACA resources with your patients—those who are currently BCBSNM members, and those who may be shopping for health insurance once the health insurance exchanges (also referred to as the insurance marketplace) go live on Oct. 1, 2013, for coverage starting Jan. 1, 2014.
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BCBSNM survey confirms: providers need to take action on ICD-10
On Oct. 1, 2014, all HIPAA-covered entities will make a leap forward, transitioning from the ICD-9 code sets to the ICD-10 code sets. We’ve written in past issues of Blue Review about the importance of preparing for ICD-10 now, especially after the Centers for Medicare & Medicaid Services (CMS) made clear the deadline will not change.
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Webinars for Behavioral Health Providers
Blue Cross and Blue Shield of New Mexico (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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Preferred specialty pharmacies for hemophilia (factor) drugs
Factor drugs, which are specialty medications used to treat hemophilia, often have unique storage or shipment requirements and usually are not stocked at retail pharmacies. BCBSNM contracts with select specialty pharmacies to ensure availability of specialty medications for our members.
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BCBSNM’s Behavioral Health Care Management Program Receives Health Utilization Management Accreditation from URAC
BCBSNM is proud to announce that in October 2012, our Behavioral Health Care Management program was awarded accreditation from URAC for Health Utilization Management.
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Our quality performance
BCBSNM’s Quality Improvement Program (QIP) develops key goals and measures performance on how well we are meeting those goals. Various quality committees help to keep our projects on target and focused. Our main goal is to improve the health of our members and your patients by helping them to understand the importance of taking better care of themselves and their families. Every year we develop a quality improvement plan that includes these goals, which is used to monitor our performance.

The overall effectiveness of our QIP is measured in various ways and is evaluated to determine success as well as opportunities for improvement. The majority of our goals were met in 2012, and we maintained our National Committee for Quality Assurance (NCQA) accreditation for the HMO, PPO, and Medicaid product lines. Multi-disciplinary teams across various departments, as well as external experts, analyzed reports and recommended opportunities, determined actions for improvement, and evaluated results.
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Advanced Treatment Comes to New Mexico Cancer Center
New Mexico Cancer Center is pleased to offer breast cancer patients an advanced form of treatment using partial breast irradiation, known as multi-catheter interstitial breast brachytherapy. One of the benefits of this advanced treatment is to shorten treatment time and minimize side effects. Many patients with early stage breast cancer are good candidates for this kind of advanced treatment. In the past, patients have had to travel out-of-state for this procedure. For further information regarding this advanced radiation treatment technique, please contact the New Mexico Cancer Center at 505-842-8171 to see if your patient is a candidate.

Forging alliances to improve the health of New Mexico’s communities
BCBSNM is committed to promoting wellness initiatives throughout our state by collaborating with health care institutions and community groups. Our 2012 Social Responsibility Report website features stories and videos that highlight our engagement in the communities where our employees, providers, and members live and work.

You can review our 2012 Social Responsibility Report available at bcbsnm2012srr.com. From the public at large to our members in your practice, BCBSNM will continue to promote health and wellness initiatives in our community.

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

There’s no need to wait on hold
The health care industry is changing rapidly with the ongoing implementation of health care reform mandates. Providers and payers are seeking new and innovative administrative methods to better support their many patients and members. As a result, BCBSNM offers administrative options that help deliver fast, simple, user-friendly methods of obtaining accurate, reliable patient information, along with confirmation of your transactions.
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ClaimsXtenTM update for Same Day Lab
As was published previously, BCBSNM is enhancing the ClaimsXten code auditing tool by adding new rules to the claims processing system, using a phased approach.
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Providers who have joined or left the BCBSNM network, April 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.

Obligation to self-report overpayments
On February 16, 2012, the Centers for Medicare & Medicaid Services (CMS) published in the Federal Register its notice of proposed rule-making regarding Providers obligations to report and return Medicaid overpayments to comply with Section 6402 of the Patient Protection and Affordable Care Act (P.L. 111-148).  Under the proposed rule, providers, including managed care organization’s contracted providers, are obligated to self-report overpayments within 60 calendar days after such provider has identified (or been notified) of the overpayment. The Human Services Department (HSD) intends to comply with this proposed rule. For more information you may review the proposed rule at 77 Fed. Reg. 9179 et seq. This rule applies to New Mexico Medicaid pursuant to HSD direction and is included in BCBSNM’s contract with HSD. 

Vaccines for Children program
A federal program called Vaccines for Children (VFC) provides free vaccines to eligible children, including those without health insurance coverage, those who are enrolled in Medicaid, American Indians, and Alaskan Natives. The State of New Mexico provides additional funding to purchase vaccines for all VFC-non-eligible children so that all New Mexico children from birth through 18 years old can receive free vaccines.
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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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