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May 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

Medicare Part D News Update: Acetaminophen (APAP) Overuse:  Risks, Developments, and Recommendations

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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Reminder: Confirm network participation and patient eligibility
Open enrollment ended on March 31, 2014, for individuals seeking health care insurance in 2014 under the Affordable Care Act (ACA). For many of your patients, this may be the first time they have health care coverage. BCBSNM is educating new members about their coverage and how to use it, but we have observed that some members may be unaware of the requirement to obtain services from an in-network provider to help maximize benefits according to their plan. We want to stress the importance of confirming your network status for the member’s plan before services are provided. As a reminder, the terms of your network contract prevent you from refusing to provide services to a BCBSNM member, regardless of where they purchased their coverage. Care provided for emergency conditions will follow our standard authorization process.
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ICD-10 update
In April, President Obama signed into law H.R. 4302, the “Protecting Access to Medicare Act.” The law amends the Social Security Act to extend Medicare payments to physicians and other provisions of the Medicare and Medicaid programs. Included in the law is a provision that delays the implementation of ICD-9 to ICD-10 until at least October 1, 2015.

BCBSNM had planned to begin ICD-10 testing with providers starting this month. As a result of this delay, BCBSNM will pause provider testing and other implementation activities until a new compliance date is announced. We have made significant progress over the last several years in readying our systems. BCBSNM is well positioned to complete the remaining scope of work once a new implementation date is announced, including end-to-end provider testing.

As more information about the new compliance date becomes available, BCBSNM will continue to provide updates in the Blue Review and on the Provider website.

This material is for educational purposes only and is not intended to dictate what codes should be used in submitting claims. Health care providers are instructed to use the most appropriate codes based upon the medical record documentation and coding guidelines.

Don’t miss out – attend an iEXCHANGE® webinar this month
We’re continuing to make enhancements to iEXCHANGE, our online tool that supports benefit preauthorization requests for inpatient admissions/extensions, as well as select behavioral health, pharmacy, and medical/surgical services. iEXCHANGE is normally available 24 hours a day, seven days a week to independently contracted BCBSNM physicians, professional providers, and facilities.* This time-saving interactive tool offers real-time responses, online communication, and tracking/reporting capabilities among other advantages.
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Our quality performance
BCBSNM’s Quality Improvement Program (QIP) develops key goals and measures performance on how well we are meeting those goals. Various quality committees help to keep our projects on target and focused. Our main goal is to improve the health of our members and your patients by helping them to understand the importance of taking better care of themselves and their families. Every year we develop a quality improvement plan that includes these goals, which is used to monitor our performance.
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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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‘Go Wild with Berries’ and other healthy living resources
New for Spring

eCards for Health® is a free, online health and wellness resource for BCBSNM members and the general public that offers a selection of eCards, screen savers, and tips for healthy living. It is designed to inspire the reader to commit to small, healthy behavior changes and share their commitments with those they care about. eCards for Health offers creative online tools to promote healthier lifestyles, which you can discuss with your patients.  
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New Be Smart. Be Well.® video highlights women and alcoholism
The National Institute on Alcohol Abuse and Alcoholism reports that nearly 18 million Americans are alcoholics or have problems with alcohol. While studies show that more men are alcoholics, the gender gap is shrinking. In addition to alcohol consumption being on the rise, binge drinking among women is also becoming a serious problem. Data from the Centers for Disease Control and Prevention show roughly 14 million women in the U.S. binge drink about three times a month, with an average of six drinks per binge. 

A new video, entitled Women and Alcoholism: Lose the Shame is now featured on the Be Smart. Be Well. website. This story profiles Amy, a pastor’s wife and mother of three, who is just one of the growing numbers of female alcoholics who are ashamed to admit that they aren’t perfect and that they are dealing with addiction. In this video, Amy shares how she overcame her shame and guilt.

Be Smart. Be Well. can be a helpful reference for your patients. When they visit BeSmartBeWell.com, they can find health news, videos, and resources on a range of important health topics including addiction, mental health, caregiving, traumatic brain injury, childhood obesity, restaurant food safety, and more. Don’t miss this opportunity to talk with your patients about these issues and refer them to this convenient resource.

These programs are for informational purposes only and are not a substitute for the sound medical judgment of a doctor. Members are encouraged to talk to their doctor if they have any questions or concerns regarding their health.

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

A new way to view your electronic remittance information
The 835 Electronic Remittance Advice (ERA) is a HIPAA-compliant electronic data file that conforms to the requirements of the American National Standards Institute (ANSI). The 835 ERA includes data content regarding claim payment, such as reason for denial or an explanation of why the total charges originally submitted were not paid in full. To receive the ERA, translator software must be built into your practice management system. This software translates the ERA into a format that can be used for automated posting and payment reconciliation.
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Providers who have joined or left the BCBSNM network, March 2014
This list reflects contracted providers for all lines of BCBSNM business: Commercial and Medicaid managed care.
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Blue Cross Community Centennial (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 800-567-8540 if you are interested in becoming a Blue Cross Community Centennial provider.

Drug List Updates


Services are funded in part under 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

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