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March 2014

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

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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Member rights and responsibilities
Our health plan members have rights and responsibilities that are listed in their Benefit Booklet or Member Handbook. Some members—for example, members with BlueDirect® and BlueEdgeSM plans—can also find these documents in the member section of our website.

Utilization management determinations
Utilization management (UM) determinations are made by licensed clinical personnel based on the benefit policy (coverage) of a member’s health plan, evidence-based medical policies, and the medical necessity of care and service. BCBSNM does not provide any reward or incentive to employees, providers, or other individuals for decisions that result in determinations that services are not covered; nor do we reward providers for underutilization of services.

If you have questions about criteria for UM decisions and official medical policy, or if you wish to discuss a UM coverage determination, you may contact a medical director at 505-816-2093. In addition, all medical policies are available for review online in the Providers section of bcbsnm.com.

Introducing our new genetic testing form
A new form is available now on our Provider website to help facilitate processing of claims for Tier 2 Current Procedural Terminology (CPT®) Molecular Pathology codes for genetic testing.
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Electronic options for pharmacy prior authorization (PA) requests
BCBSNM continues to enhance the process for submitting PA requests for drugs that are a part of our pharmacy PA program.
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ICD-10 testing with BCBSNM to begin April 1, 2014
The October 1, 2014, federally mandated transition to ICD-10 is only months away. Providers, payers, and all other HIPAA-covered entities should be preparing for the transition.
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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

ClaimsXtenTM second 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 and are not considered changes to the software version. BCBSNM will normally 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 Provider website.
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Reminder: CMS-1500 paper claim form (version 02/12)
Previous articles have referenced the transition from the previous version of the paper CMS-1500 claim form (08/05) to the revised version (02/12). As a reminder, the transition timeline, which aligns with Medicare’s timeline, is as follows:
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Not enrolled for Electronic Funds Transfer (EFT)?
EFT is a convenient, confidential, and secure method of payment. Using EFT means your payments are delivered directly to the financial institution of your choice. This alternative to receiving paper checks can help save you time while reducing the risk of lost or misrouted payments. In general, funds will be transferred to the provider’s bank in two banking days, after the claim is finalized.*

There’s no cost to enroll, and the enrollment process is easier than ever. BCBSNM independently contracted providers who are registered with Availity may complete the EFT and Electronic Remittance Advice (ERA) enrollment process online via the secure Availity provider portal. Please note that you must be a registered Availity user to complete the online enrollment process – visit availity.com for more information. Or, to enroll by submitting a paper form, complete the EFT Authorization Agreement, which is available in the Claims and Eligibility/Electronic Commerce section of our website.

*Add one day if the normal day falls on a banking holiday. EFT payment dates also may be affected by our corporate holiday schedule. Visit the Claims and Eligibility/Electronic Commerce section of our website at bcbsnm.com/provider for details.

Availity is a registered trademark of Availity, LLC. Availity is a separate company that operates a health information network to provide electronic information exchange services to medical professionals. Availity provides administrative services to BCBSNM. 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.

A closer look: Documentation and coding for chronic kidney disease
This month’s Blue Review highlights documentation and coding for Chronic Kidney Disease (CKD) under the ICD-9-CM and ICD-10-CM code sets.
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Providers who have joined or left the BCBSNM network, January 2014
This list reflects contracted providers for all lines of BCBSNM business: Commercial and Medicaid managed care.
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Blue Cross Community CentennialSM (Medicaid)

Not yet contracted?
BCBSNM’s Medicaid plan is Blue Cross Community Centennial.

Providers who are participating in commercial BCBSNM products are not automatically participating providers in Blue Cross Community Centennial. To become a Blue Cross Community Centennial provider, you must sign a Medicaid amendment to your Medical Services Entity Agreement (MSEA).

If you have any questions, please call 505-837-8800 or 1-800-567-8540 if you are interested in becoming a Blue Cross Community Centennial provider.

Reminder: Update your enrollment information
Due to new Centennial Care requirements, all enrollment information (changes to demographics, licensure or certification, provider status, etc.) must be updated on the NM Medicaid Provider Web Portal.
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Services are funded in part under contract with the State of New Mexico.

Blue Cross and Blue Shield of New Mexico is a Division of Health Care Service Corporation,
a Mutual Legal Reserve Company, an Independent Licensee of the Blue Cross and Blue Shield Association

Blue Cross Medicare AdvantageSM

Stars/HEDIS® Focused 2014 Medicare Advantage formulary
New 2014 prescription drug benefits for Blue Cross Medicare Advantage HMO members have been designed to help create savings on medications that treat conditions such as diabetes, high blood pressure, high cholesterol, depression, osteoporosis, and many others.
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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

© Copyright 2014. All Rights Reserved.
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