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August 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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Commercial Drug List Updates for July 2013

SM Drug List Updates

High-tech imaging providers: Action needed
We encourage you to complete your OptiNet® assessment today! OptiNet optimizes the efficiency of the BCBSNM Radiology Quality Initiative (RQI) program by collecting specific data from imaging providers. The data are used to evaluate the capabilities of imaging providers and help promote patient safety, cost effectiveness, and accessibility of care.
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Calling all Primary Care Providers (PCPs): How to optimize patient safety after hours
BCBSNM annually assesses PCP after-hour messaging as part of our commitment to ensuring high safety standards to our members when they are in need of care outside of normal working hours. Our minimum standards for after-hour messaging can be found in Section 4.2.4 of the Blues Provider Reference Manual.
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The critical importance of care coordination
BCBSNM performs an annual Provider Satisfaction Survey. The survey includes items about continuity and coordination of care in order to ensure members are attaining the highest quality of care possible, which depends largely upon communication between specialists, hospitals, and PCPs. Our goal is to see statistically significant increases in provider satisfaction with coordination of care.
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Hemophilia (factor) drugs: Supporting member awareness
Previous articles have reminded you that specialty medications approved for self-administration by the U.S. Food and Drug Administration (FDA) should not be submitted on professional/ancillary electronic (ANSI 837P) or paper (CMS-1500) claims. This includes hemophilia (factor) drugs.
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Three easy ways to get started with ICD-10
The transition to ICD-10 has been a hot topic in Blue Review and across the health care industry. ICD-10 may be daunting for providers, especially small- and medium-sized practices, but there are three easy ways to get started on your transition to ICD-10:
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Moving into the next phase of Administrative Simplification
Administrative Simplification was introduced as a component of the Health Insurance Portability and Accountability Act (HIPAA) to streamline administrative processes while increasing security of protected health information. Under HIPAA, a standardized format and technical structure were adopted for electronic data interchange (EDI) transactions between HIPAA-covered entities. Covered entities include all health benefit plans, health information technology vendors, physicians, facilities, and other health care professionals.
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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) pricing implementation effective Nov. 1, 2013
Previous articles emphasized the importance of including NDCs and related data (qualifier, unit of measure, number of units, billable charge), along with the appropriate HCPCS or Current Procedural Terminology (CPT®) code when drugs are billed on professional/ancillary electronic (ANSI 837P) and paper (CMS-1500) claims.
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ClaimsXtenTM third quarter 2013 updates
BCBSNM reviews new and revised Current Procedural Terminology (CPT®) and HCPCS codes on a quarterly basis. Codes are periodically added to or deleted from the ClaimsXten software by McKesson without changing the software version. BCBSNM will now load this additional data to the BCBSNM claim processing system within 60 to 90 days after receipt from McKesson and will confirm the effective date on the BCBSNM website. Advance notification of updates to the ClaimsXten software version (i.e., change from ClaimsXten version 4.1 to 4.4) will continue to be posted on the BCBSNM website.
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Detailed claim information available online
BCBSNM offers detailed claim status information through online vendor options, such as the Availity® Claim Research Tool (CRT).*
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Providers who have joined or left the BCBSNM network, June 2013
This list reflects contracted providers for all lines of BCBSNM business: Commercial and Medicaid managed care (BlueSalud).
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Not yet contracted for BlueSalud? What about Centennial Care?
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).

BlueSalud is effective until December 31, 2013. Beginning January 1, 2014, BCBSNM will continue to serve as a Managed Care Organization (MCO) with the new State of New Mexico Medicaid program, Centennial Care.  A New Mexico Medicaid Managed Care Amendment was mailed to BCBSNM participating providers for review. To begin treating BCBSNM’s future Medicaid managed care members on and after January 1, 2014, we ask that you please return the signed amendment (or you may fax the entire amendment to 505-816-2688).

After the signed amendment has been received, it will be executed by BCBSNM and a signed copy will be returned to your office, with an effective date of January 1, 2014.

If you have any questions please call 505-837-8800 or 1-800-567-8540.

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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