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November 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; email 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 News Update: Why is estrogen replacement therapy considered a
potentially high risk medication?

Pharmacy program introduces electronic Prior Authorization process
As mentioned in last month’s Blue Review, Blue Cross and Blue Shield of New Mexico (BCBSNM) has enhanced the process for submitting Prior Authorization (PA) requests for drugs that are part of our commercial PA program. (Note: This enhancement does not apply to PA requests for BlueSaludSM members.)
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Risk Adjustment
Risk Adjustment is a provision of the Affordable Care Act (ACA) and is intended to promote the success of the law’s new Health Insurance Marketplace. Risk Adjustment levels the playing field by discouraging adverse selection of members and is accomplished via a two-step process: risk assessment, which evaluates the health risk status of an individual to create a clinical profile; and rate adjustment, which determines the resource utilization needed to provide medical care to an individual. The Risk Adjustment methodology serves as a mechanism to convey the illness burden a provider is managing within their patient population, thus allowing for fair comparison of quality outcomes and cost performance.
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Important update to the BCBSNM Provider Reference Manual
Please note that Section 17.13, Provider Rights and Responsibilities, of the Blues Provider Reference Manual has been updated to include the italicized bullet below:
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How important is your documentation for ICD-10?
The countdown to the transition to ICD-10 has begun, and we are less than a year away. The U.S. Department of Health and Human Services (HHS) has required all HIPAA-covered entities to make the switch from ICD-9 to ICD-10 on October 1, 2014. In previous issues of Blue Review, we’ve shared resources for planning, tips for evaluating technology vendors, information about education training, and more. All of these elements are part of one core objective that links ICD-10 to many other health care initiatives: improving documentation.
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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

Enhanced voucher numbering process
Blue Cross Blue Shield of New Mexico (BCBSNM) is enhancing the numbering system for vouchers used for payments to providers. The current process generates zeros as place holders in the voucher number field when no payment is being issued to a provider. The system will now create a new eight character voucher number beginning with the letter “N” and subsequent unique seven digit number. The generation of a valid voucher number eliminates the problems caused when all zeros were used to indicate no payment on the Electronic Payment Summary (EPS) and paper Provider Claim Summary (PCS).
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Providers who have joined or left the BCBSNM network, September 2013
This list reflects contracted providers for all lines of BCBSNM business: Commercial and Medicaid managed care (BlueSaludSM).
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BlueSaludSM and Blue Cross Community CentennialSM

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. BCBSNM’s Medicaid plan for 2014 is Blue Cross Community CentennialSM. A New Mexico Medicaid Managed Care Amendment was mailed to participating BCBSNM 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.

Services are funded in part under a contract with the State of New Mexico.

Blue Cross and Blue Shield of New Mexico refers to HCSC Insurance Services Company (HISC), which is a wholly owned subsidiary of Health Care Service Corporation (HCSC), a Mutual Legal Reserve Company. Both HISC and HCSC are Independent Licensees of the Blue Cross and Blue Shield Association.


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

© Copyright 2013. All Rights Reserved.
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