Please distribute this newsletter, which contains claims, billing, Medical Policy, and other important information, to all health care providers and administrative staff that this e-mail address represents. Thank you. Blue Review: Share the wealth!
Each issue of Blue Review is packed with valuable information. It is very important that you share Blue Review with your billing departments/entities. Many issues contain articles relevant to department employees, such as system and coding updates, billing and reimbursement, new account groups, federal mandates, and electronic commerce solutions. You can find Blue Review online.
Do we have your correct information?
If you have moved or made other changes to your practice contact information, please complete our quick and easy online form to share your updates with us. Thank you!
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.
While information on new or revised Medical Policies is also published in this newsletter for your convenience, please visit our website for access to the most complete and up-to-date information. If you have any questions about BCBSNM’s Medical Policies, please call the Office of the Medical Director at (505) 816-2093.
Diagnosis and Treatment of Chronic Cerebrospinal Venous Insufficiency in Multiple Sclerosis
Extracorporeal Photopheresis (ECP)
Pulmonary Arterial Hypertension (PAH) Drug Therapies
Behavioral Health Program changes
Effective January 1, 2012, BCBSNM implemented changes to the Behavioral Health Program* by introducing the Focused Outpatient Management Program. This program was developed as a new and innovative way to address the unique aspects of managing behavioral health conditions and treatment, and continue to ensure that members receive medically necessary and appropriate quality behavioral health outpatient care. Please note: These changes do not affect our BlueSaludSM membership. Behavioral health benefits for BlueSalud members continue to be administered by OptumHealthSM New Mexico.
We have updated the frequently asked questions. New program information is shaded within the updated document. If you have any questions about the Behavioral Health Program, please contact your BCBSNM network representative.
*The Behavioral Health program is available only to those members whose health plans include behavioral health benefits through BCBSNM.
On track with ACA: Affordable Care Act updates
ACA has impacted the health care industry through the implementation of many different provisions that will transform the way health care is delivered. The changes brought about by health care reform and ACA will continue to provide significant challenges and opportunities for the health care industry.
The key goals of ACA are to expand health care coverage to approximately 29 million Americans using existing means and programs, to remove barriers to coverage, and to address affordability issues. Provisions in the law address specific issues related to these goals, including private market reforms, the establishment of public exchanges, individual and employer mandates, delivery system reforms, Medicare reforms, and Medicaid expansions.
BCBSNM will share information about ACA and its possible effect on the health care industry, you, and your patients. For now, we invite you to visit our website, where you will find an overview of many ACA provisions, as well as links to external resources on health care reform. Updates to the BlueSalud Drug List
“Bath Salts”: A new designer drug
What comes to mind when you hear the words “bath salts”? Unfortunately, the term has taken on a darker and considerably more dangerous connotation. “Bath salts” is slang for a new over-the-counter drug of abuse that is making headlines throughout the country. Although the name may appear harmless, this new drug is anything but. Bath salts are now a leading cause of emergency room visits, hospital admissions, and calls to poison control centers.
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BCBSNM Specialty Pharmacy Program
BCBSNM offers several programs that help deliver specialty pharmaceuticals directly to providers or our members who are undergoing treatment for a complex, chronic illness.
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Health insurance 101: Fully insured group plans vs. self-funded group plans—what’s the difference?
BCBSNM offers health plan coverage to individuals and to employers. The latter is known as group coverage. There are two types of group coverage: Fully insured and self-funded.
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Pharmacy program utilization management transition
The BCBSNM pharmacy optimization initiative includes a number of strategies to help improve the value of our drug benefits, monitor drug safety, and ultimately improve health outcomes for our members.
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Annual HEDIS® project begins February 2012
During the next few months, BCBSNM nurses will be contacting your office or facility in preparation for the gathering of information for the nationally validated Healthcare Effectiveness Data and Information Set (HEDIS).
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Office Staff Network Services contacts and related service areas
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 regional map Providers who have joined or left the BCBSNM network, December 2011
BCBSNM makes no endorsements, representations, or warranties about any products or services offered by independent third-party vendors mentioned in this newsletter. The vendors are solely responsible for the products or services offered by them. If you have any questions about the products or services mentioned in this newsletter, contact the vendor directly.