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September 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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Medicare Part D Formulary Updates: Second Quarter 2013

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 inform
ation.

Spacers improve asthma outcomes
According to the National Institute of Health’s National Asthma Education and Prevention Program, all patients taking medium-to-high doses of inhaled corticosteroids are recommended to use a spacer/holding chamber with a metered dose inhaler (MDI).
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Blue Cross and Blue Shield of New Mexico will be prepared for ICD-10
The transition to ICD-10, a mandate set by the US Department of Health and Human Services, means that all HIPAA-covered entities must discontinue the use of ICD-9 codes for service or discharge dates on or after Oct. 1, 2014, replacing those codes with the more detailed ICD-10 code sets. Previous Blue Review articles describe some of the benefits of ICD-10 and the planning required for the transition, including technology considerations, staff training, and budgeting tips. This month, we want to share some of our own planning activities at BCBSNM as well as our commitment to being ready to meet the transition deadline. 
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The Affordable Care Act: Open enrollment for Health Insurance Marketplaces is October 1, 2013
Blue Cross and Blue Shield of New Mexico (BCBSNM) shared information in the May 2013 issue of Blue Review about how we are helping to prepare our communities for change resulting from the Affordable Care Act (ACA). The amount of change can seem overwhelming to you and your patients, so it is helpful to understand the basics of the Health Insurance Marketplace open enrollment.
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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

Coming Soon: Revised CMS-1500 paper claim form (version 02/12)
The National Uniform Claim Committee (NUCC) maintains the CMS-1500 paper claim form and makes updates according to health care industry requirements. NUCC recently announced that the health care industry will transition to a revised version of the CMS-1500 paper claim form in early 2014.
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Reminder: Initial treatment dates on ANSI version 5010
As a reminder, the ANSI v5010 format for electronic claims no longer has a field for the date your patient was first treated for a particular condition by you or a referring physician. However, you may receive a letter from BCBSNM requesting this additional information.

When you receive this letter, you may submit the requested information to BCBSNM in one of the following ways:

  • Electronic (preferred method) – Fill in the date and fax the letter to the number indicated on the letter
  • Phone – Call the Customer Service number indicated on the letter to provide the date over the phone
  • U.S. Mail – Fill in the date and mail to the return address indicated on the letter

If you utilize a billing service or clearinghouse to submit electronic claims on your behalf, please check with them to ensure they are aware of the above information.

We appreciate your patience and cooperation.

Providers who have joined or left the BCBSNM network, July 2013
This list reflects contracted providers for all lines of BCBSNM business: Commercial and Medicaid managed care (BlueSaludSM).

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BlueSaludSM

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 through December 31, 2013. Beginning January 1, 2014, BCBSNM will continue 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 sign and return the 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

Change in contact information for medical-related dental services
BCBSNM appreciates the dental care you provide our BlueSalud members. Effective August 1, 2013, calls and faxed requests for predetermination and preauthorization for medical-related dental services payable under the medical benefit will be managed by a different unit here at BCBSNM. 

Please begin using the following numbers for your questions or requests related to medical-related dental services requiring preauthorization or predetermination for BlueSalud members:

  • Dental Salud Phone Number: 877-232-5518
  • Dental Salud Fax Number: 505-816-3854

We believe this will be a smooth transition and appreciate your posting the above numbers for future calls and faxes.

Blue Cross Community Centennial provider training
BCBSNM would like to invite you to a live training seminar being held in a city near you on Blue Cross Community Centennial. This new Medicaid program will be effective on 1/1/2014. This training is for all provider types including behavioral health and long-term care providers. Please see the training schedule below and RSVP to attend a training session today.
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BlueSalud services are funded in part under contract with the State of New Mexico.

Blue Medicare Advantage (HMO)SM

In the Know: Medicare Marketing Guidelines for Providers
The 2014 Centers for Medicare & Medicaid Services (CMS) annual election period for beneficiaries is fast approaching. For those providers who are independently contracted with BCBSNM to provide Blue Medicare Advantage (HMO) services, it is important to keep in mind the rules established by CMS when marketing to potential enrollees.
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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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