November 2011

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 Health Services at (505) 816-2093.

Effective Date

Policy Number

Policy Name



Prosthetics, Except Lower Limb Prosthetics



Wheelchairs and Accessories



Lower Limb Prosthetics, Including Microprocessor Prosthetics



Intravitreal Corticosteroid Implants

BCBSNM scores high in provider satisfaction survey
The Myers Group (TMG), a National Committee for Quality Assurance (NCQA) Certified Survey Vendor, conducted the 2011 Provider Satisfaction Survey of both BCBSNM Medicaid and commercial plan providers. Information from this survey allows BCBSNM to measure how well we are meeting the needs and expectations of providers in our networks. The survey identifies how providers perceive the quality of service provided by BCBSNM as compared to BCBSNM plan performance in 2010, competitor plans serving New Mexico, and TMG's book of business.
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Are you a sole proprietor? You may need a Type 2 NPI
All individual professional providers who either conduct business using HIPAA-standard transactions or have business conducted on their behalf by an employer are required to obtain a Type 1 National Provider Identifier (NPI). In the latter case, this Type 1 NPI is used to identify the professional that rendered the service being billed on the claim.

If you are a sole proprietor wishing to incorporate your practice as an organization, you will need to complete the following steps (after you have taken the legal steps to create your organization):
  1. Obtain a Type 2 Organizational NPI: Apply online by going to the National Plan and Provider Enumeration System (NPPES) website.
  2. Request a new provider record ID packet: After you receive your new Type 2 NPI, complete the Group Provider Record/Contracting Packet application and return it to BCBSNM (follow the instructions on the form).
  3. Submit your completed packet to BCBSNM: Specify that your new Type 2 NPI should be designated as your billing NPI in the BCBSNM system, with your Type 1 NPI designated as your rendering NPI. Be sure you have notified Medicare also or you may have problems with processing crossover claims.

Following the above steps will help ensure the correct information is on file with BCBSNM in order for your claims to be processed and paid accordingly.

Are you ready to receive ANSI Version 5010 (v5010) A1 835 test files?
Effective immediately, BCBSNM is ready to send ANSI 835 Electronic Remittance Advice (ERA) transactions in an ANSI v5010A1 format. We need your approval and confirmation that you and your billing service and/or clearinghouse are ready to receive these transactions.
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ANSI Version 5010 (v5010): The final countdown
We are only three months away from the ANSI v5010 conversion deadline. As of January 1, 2012, the ANSI v5010 compliance date, all ANSI v4010A1 claims will be rejected by BCBSNM as invalid formats. Other HIPAA-standard, electronic data interchange (EDI) transactions such as electronic claim status, eligibility, and benefits, as well as the electronic remittance advice, are also affected by the ANSI v5010 conversion. Additionally, in accordance with HIPAA guidelines, the transition to ANSI v5010 is a prerequisite for the mandated implementation of ICD-10 on October 1, 2013.
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Lovelace Medical Center in Albuquerque offers inpatient psychiatric services for seniors
Lovelace Medical Center's inpatient psychiatric unit is designed for the unique behavioral health needs of individuals age 50 and older. This unit provides short-term, acute-care treatment for a range of issues, including depression, anxiety, substance abuse, grief, and more. For more information, call (505) 727-8855.

Updates to the BlueSalud Drug List

Results from the 2010 National Survey on Drug Use and Health: Summary of National Findings on Illicit Drug Use

Office Staff
Providers who have joined or left the BCBSNM network, September 2011

Ideas for articles and letters to the editor are welcome; e-mail
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.

BlueSalud services are funded in part under contract with the State 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.



P.O.Box 27630, Albuquerque, NM 87125-7630

© Copyright 2011. Health Care Service Corporation. All Rights Reserved.
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