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July 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

Keep up-to-date with the latest news and updates!
Along with all the valuable information included in our Blue Review newsletter, the News and Updates section of our website gives the latest updates in webinar schedules, current programs, and policies.

The eCommerce Alerts section provides notification of system enhancements, upgrades, new functionality, and any Electronic Data Interchange (EDI) transaction issues that may affect claims processing, payment, or remittance delivery.

We periodically update the forms on our provider website, so it’s important to check often to help ensure you are using the most current version. Forms are organized by category in our Education and Reference section.

Be sure to visit us online at bcbsnm.com/provider to access the most updated information.

Provider education webinars available
Blue Cross and Blue Shield of New Mexico (BCBSNM) offers complimentary educational webinar sessions for our provider community and their staff. Some of the current training modules are:

  • AvailityTM
  • BlueCard®
  • Electronic Commerce
  • Interactive Voice Response (IVR)
  • Refund and Recoupment
  • Provider Website tour

Visit our Provider Training page for more information and to register. If you have questions, please email us.

Medicare Part D News Update: Antipsychotic Use in the Elderly

Drug List Updates

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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“Got Shots? Protect Tots!” event planned for August 2–16
The New Mexico Department of Health, New Mexico Primary Care Association, and New Mexico Immunization Coalition are hosting the 2014 “Got Shots?” event taking place August 2 through August 16, 2014. Providers are encouraged to open their doors on one or more event days, including evening and weekend hours, to see any child who presents for immunizations without an appointment, regardless of whether the child is a current patient or has insurance.
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The Affordable Care Act (ACA) and the Multi-State Plan Program
BCBSNM is participating, along with other Blues Plans, in the Multi-state Plan Program (MSPP). ACA created the MSPP to provide consumers with additional health care choices on the Health Insurance Marketplaces.
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Second quarter 2014 pharmacy optimization initiative highlights
In the second quarter of 2014, BCBSNM focused on the expansion of several clinical pharmacy programs with an emphasis on identifying patients with potential drug therapy concerns related to the safe and effective use of medications.
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Supporting appropriate use of prescribed controlled substance medications
The BCBSNM Pharmacy Program includes initiatives to help educate members on the importance of taking medications as prescribed. Members are advised to follow their physicians’ instructions in accordance with the individualized treatment plan that is developed for each member. BCBSNM recognizes that additional support may be needed to help monitor appropriate use, particularly for patients with prescribed drug therapy regimens that include controlled substances.

Effective June 30, 2014, our Controlled Substance Program will be enhanced to include new criteria aimed at identifying members with controlled substance utilization patterns that may indicate potential abuse, misuse, or improper utilization. As part of this program, BCBSNM care management teams will work together and also involve providers to help develop action plans that support our members’ care. For example, a plan of action may include applying quantity limits for identified members. Additionally, BCBSNM may assist with coordination of care for complex cases where members may be receiving care from multiple physicians.

Demonstrating our commitment to BCBSNM communities
BCBSNM is pleased to share our 2013 Social Responsibility Report. This year’s report captures the passion and commitment that our employees exhibited in 2013 as they worked to make a difference in their communities. Through personal stories and compelling videos, this report highlights the efforts BCBSNM employees made in:
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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

New on Availity: Option to contact BCBSNM
We’d like to take this opportunity to thank you for making electronic options your first choice when conducting business with BCBSNM.
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Introducing electronic provider access for out-of-area members
Effective July 19, 2014, Electronic Provider Access (EPA) will be available to BCBSNM independently contracted providers who are registered Availity Web Portal users. EPA will enable you to initiate online pre-service reviews for out-of-area Blue Plan members, just as you do now for our local members.
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ClaimsXtenTM third 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 normally loads 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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Providers who have joined or left the BCBSNM network, May 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?
Blue Cross and Blue Shield of New Mexico’s (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 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.

Drug List Updates

Screening for Clinical Depression Program
The Blue Cross Community Centennial Plan is committed to promoting annual screening and follow-up treatment for depression in the primary care setting. Although many patients may present to their primary care office with physical symptoms such as pain, poor sleep, or poor appetite, their comorbid diagnosis of depression often goes unrecognized. Primary care physicians may not have the tools or the time needed to screen or treat such patients. Blue Cross Community Centennial understands these challenges and is determined to help.
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Antidepressant Medication Management Program
Blue Cross Community Centennial is committed to improving the rate at which members remain on antidepressant medications after newly diagnosed and treated depression.
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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 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 2014. All Rights Reserved.
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