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August 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

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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Benefits Value Advisor available to members
BCBSNM Benefits Value Advisor (BVA) service, launched on January 1, 2014, is available to BCBSNM members to help maximize their health insurance benefits.
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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 November 2014 Update
Beginning on or after November 3, 2014, BCBSNM will enhance the ClaimsXten code auditing tool by adding two new rules into our claim processing system. 
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Notice of fee schedule updates
In an effort to keep our contracted providers informed, BCBSNM is notifying providers of any significant changes to the physician fee schedules. Therefore, the changes are noted below:

  • Effective November 1, 2014, procedure code J1745 will be updated.

The information above is not intended to be an exhaustive listing of all the changes.
Annual and quarterly fee schedule updates can also be requested by using the Fee Schedule Request form. Specific code changes that are listed above can also be obtained by downloading the Fee Schedule Request Form and specifically requesting the updates on the code(s) listed in the Blue Review. The form is available in the Education and Reference / Forms section of our Provider website.

Did you know?
The Claims & Eligibility section of the BCBSNM provider website includes information your office may need in obtaining eligibility and benefits, claims status, as well as claim submission guidelines such as:

  • BlueCard® Program claim filing
  • Electronic Commerce services
  • Interactive Voice Response (IVR) System
  • Medicare Advantage Private Fee-for-Service tool
  • Preauthorization
  • Electronic claims filing
  • Billing National Drug Codes (NDCs)
  • Timely filing requirements
  • Tips for preventing claim delays

More detailed information can be found in the Blues Provider Reference Manual. Links to the manual are also located under the Education & Reference and the Standards & Requirements tabs.

Providers who have joined or left the BCBSNM network, June 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 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.

Rapid response for your pharmacy prior authorization requests
Are you experiencing delays in processing of your prior authorization pharmacy requests? Here's how you can prevent delays and even expedite responses to your routine prior authorization requests.
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Telehealth services available
BCBSNM covers telehealth services for our Blue Cross Community Centennial members.  “Telehealth” (or telemonitoring) is the use of telecommunications and information technology to provide access to health assessment, diagnosis, intervention, consultation, supervision, and information across distance.  While it is preferred for providers to administer services to members in person, telehealth may be provided at remote health and medical offices in which there is no provider accessible to meet our members’ needs.
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Centennial Care copayment changes
The New Mexico Human Services Department (HSD) has directed the Managed Care Organizations to make changes in copayments for Children’s Health Insurance Program (CHIP), Working Disabled Individuals (WDI), Alternative Benefit Plan (ABP), ABP-Exempt (medically frail), and standard Medicaid recipients effective with dates of service on or after August 1, 2014.
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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, 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 and Blue Shield of New Mexico is committed to the highest standards of business ethics and integrity as well as strict observance and compliance with the laws and regulations governing its business operations.

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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