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December 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 email 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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IMPORTANT: Use in-network labs
It has come to our attention that some provider offices have been referring patients to out-of-network labs. This has resulted in members being balance billed and having increased out-of-pocket costs. In order to ensure member satisfaction, please utilize in-network labs.
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Blue Cross and Blue Shield of New Mexico (BCBSNM) announces behavioral health (BH) quality improvement results
BCBSNM continually monitors and evaluates our BH care management program through the Behavioral Health Quality Improvement Program (BHQIP). The BHQIP identifies program enhancement opportunities benefiting members, physicians, and other health care providers and shares information that can be used to achieve the best possible health outcomes.
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Beware! Health care reform law scammers are on the prowl
Some scam artists are using the new health care reform law to take consumers’ money and/or commit identity theft. Now that it’s possible to sign up for health insurance under the new federal health care law, the Affordable Care Act (ACA), watch out for scam artists. They may use this as a new way to steal Social Security, bank account information, and credit card numbers. Help your patients by sharing these tips to avoid the scams.
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Diabetes Self-Management Training (DSMT) at New Heart
DSMT is a nationally standardized program accredited by the American Diabetes Association and the American Association of Diabetes Educators. At New Heart, the program consists of a 10-hour interactive educational experience designed to give patients the skills they need to manage their diabetes effectively between office visits. The curriculum addresses a range of issues, including blood glucose monitoring, exercise, eating, medications, coping, problem solving, the importance of ophthalmology and podiatry exams, and planning for the future. The course is taught by a certified diabetes educator with the assistance of an exercise specialist and a behavioral health specialist.

Two additional features of the New Heart program are a one-hour cooking demonstration and food tasting, as well as a free two-month membership to the New Heart gym. The program is a one-time benefit covered by most insurance companies (copays may apply). As a complement to the care you already provide, DSMT can help improve patient confidence and potentially reduce or delay the onset of complications. Call New Heart at 505-881-8195 for more 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.

Updates to Roche Blood Glucose Meter Program*
BCBSNM offers a choice of blood glucose meters to help our members with diabetes manage their condition. One of the brands, Roche, is modifying the process members use to obtain a blood glucose meter and is making their contact information consistent for all BCBSNM members. 
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Helpful Hints for iEXCHANGE®: Why you should complete your user profile
Have you completed your iEXCHANGE user profile? If you have, you can reset your password online. Registered iEXCHANGE users can complete the iEXCHANGE user profile with their name and email address and by selecting a security question and answer to activate the password reset feature. Once the reset feature is activated, you will have the ability to reset your password by clicking on the “Forgot Password, Click here” link on the iEXCHANGE Provider Login page.

AIM Specialty Health® (AIM) update
In the October issue of the Blue Review, BCBSNM announced that the Radiology Quality Initiative (RQI) program administered by AIM would be expanded, effective January 1, 2014, to include: Stress Echocardiography, Resting Transthoracic Echocardiography, and Transesophageal Echocardiography. BCBSNM is delaying this implementation.  Existing services currently included in the RQI program will remain in place. BCBSNM will notify providers in advance when this expansion is rescheduled.

AIM Specialty Health is a member of the WellPoint family of companies and an independent third party vendor that is solely responsible for its products and services. BCBSNM makes no endorsement, representations or warranties regarding any products or services offered by independent third party vendors. If you have any questions about the products or services offered by such vendors, you should contact the vendors directly.

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

Attention: paper claim submitters
If you submit paper claims and claims correspondence to BCBSNM, it is important to ensure you are using the correct mailing address. Unless otherwise instructed, all paper claims and claims correspondence should be mailed to the following address:

Blue Cross and Blue Shield of New Mexico
P.O. Box 27630
Albuquerque, New Mexico 87125

Consider Your Electronic Options
Would you like a faster solution that reduces paper waste while also increasing security for your patients’ protected health information? The best way to do business with BCBSNM is to utilize electronic options. For more information about getting started with electronic claim submission, visit the Claims and Eligibility/Electronic Commerce section of our website.

Reminder: CMS-1500 paper claim form (version 02/12) available January 2014
As reported in the September 2013 issue of Blue Review, the National Uniform Claim Committee (NUCC) recently announced that in early January 2014, the health care industry will transition to a revised version of the CMS-1500 paper claim form: OMB-0938-1197 FORM 1500 (02-12).
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Why checking eligibility and benefits is important
Whenever a patient visits a provider’s office and before services are rendered, your office staff should ask to see the member’s ID card and check for eligibility and benefits. Significant changes to the health care industry are now here and, while it has always been important to check eligibility and benefits, the following are additional reasons to incorporate this procedure for every visit, even if multiple visits were approved:
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Notice regarding annual benefit updates
BCBSNM will soon begin processing annual benefit changes for 2014. Beginning January 2014, if you are using an online Web vendor to obtain patient eligibility and benefits, you may be instructed to contact BCBSNM Provider Customer Service. Please be aware, BCBSNM expects a substantial increase of calls due to the large number of policy changes underway. To avoid lengthy hold times, providers are encouraged to limit their general eligibility and benefit calls to patients who are scheduled for an upcoming appointment. If your patient has a scheduled appointment, please contact the appropriate provider customer service number listed on their identification card.

We appreciate your patience while we update our files.

ClaimsXtenTM first quarter 2014 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 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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Investigating health care fraud
Fraud is one of the factors contributing to the steep rise in health care costs. BCBSNM actively participates in inquiries and investigations to accurately identify and appropriately address potential fraudulent activities through our Special Investigations Department (SID). The SID is committed to fighting fraud, reducing health care costs, and helping to protect the integrity of the BCBSNM-contracted provider network.
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Providers who have joined or left the BCBSNM network, October 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?
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 Centennial.
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Registration is required for Centennial Care
The Human Services Department (HSD) requires any provider who files a New Mexico (NM) Medicaid claim with a Managed Care Organization (MCO) for Centennial Care, and who is not currently enrolled as either a Fee for Service (FFS) or MCO-only provider to register on the NM Medicaid Provider Web Portal.
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Medicaid Pharmacy Program introduces electronic prior authorization
BCBSNM has enhanced the process for submitting Prior Authorization (PA) requests for drugs that are part of our Medicaid PA program.
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Nursing facility billing requirements
The Human Services Department (HSD) has standardized the Nursing Facility (NF) billing requirements for all Medicaid payers. Please bill these services with the codes outlined below on the UB-04 form.
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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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