December 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



Genotyping for 9p21 Genetic Polymorphisms to Predict Cardiovascular Disease Risk



Cosmetic and Reconstructive Procedures

Pharmacy program update: 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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BCBSNM condition management programs support physicians
Our condition management (DM) programs are based on the belief that to optimize health outcomes, patients with chronic health conditions are best served by a collaboration of their physician's professional clinical care and self-care (the actions patients take to manage their conditions).
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Fax option to be removed for high-tech imaging order entry requests
Please note that as of January 1, 2012, all RQI number requests must be submitted online or by telephone, as AIM will no longer be supporting fax requests. (The fax option will remain available for physicians who are submitting clinical information for existing requests.)
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Medical record requests: Include our letter as your cover sheet
When you receive a letter from BCBSNM requesting additional information such as medical records or certificates of medical necessity, please use the letter as a cover sheet when sending the requested information to us. This letter contains a barcode in the upper right corner of the page to help ensure that the information you send is matched directly to the appropriate file and/or claim. Do not submit a Claim Review Form in addition to the letter, as this could delay the review process. Thank you for your cooperation!

ANSI Version 5010 (v5010) compliance reminders
We're including a summary of ANSI v5010-related billing changes and testing reminders from previous Blue Review articles to call your attention to these important details. If you use the services of a billing entity (a billing service and/or clearinghouse), please be sure to check with them to help ensure that they are fully prepared to conduct and/or support ANSI v5010 transactions submitted on your behalf.
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Electronic funds transfer (EFT) helps protect your claim payments
The EFT Agreement you sign with us prevents BCBSNM from debiting your bank account to satisfy payment obligations. Any recoupment deductions must be made prior to release of payments we are sending you, and not from your bank account.
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Behavioral health providers: Save time — go online!
Every moment counts, especially when your patients are waiting. Setting aside time to make phone calls to BCBSNM can present an administrative challenge. Electronic options allow you to go online at your convenience to obtain patient eligibility and benefits, check claim status, and conduct other claim-related inquiries.
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Online member liability estimator now available
The Availity® CareCost EstimatorSM (CCE), developed jointly with Availity, is a member liability estimator* (MLE) tool. The CCE reviews the available information submitted: Primary diagnosis, procedures performed, available benefits, and contractual allowances. Then it calculates an estimated out-of-pocket cost in real time for office and outpatient services provided to BCBSNM members.
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CHILI: Child-Health Immunization Learning Initiative
The goal of the New Mexico Department of Health (DOH) Immunization Program is to ensure that all New Mexicans are properly immunized against vaccine-preventable diseases. The DOH offers CHILI, a comprehensive training course, taught by DOH nurses specially trained in regional immunization. Course topics include:

  • The importance of up-to-date child immunizations
  • Childhood immunization schedules
  • Protocols for vaccine storage and handling

CHILI offers 2.08 Continuing Nursing Education (CNE) credits. There will be a training session on December 7 from 3 p.m. to 5 p.m. All training will take place at Bank of the West, 5301 Central NE (Central and San Mateo), Suite 800, in Albuquerque. For more information or to register, contact: Tina Cutler, RN, at (505) 307-0242 or

New Exercise and Healthy Eating eCard available
Do you exercise regularly, but don't eat healthfully? Do you eat healthfully, but don't exercise? Studies show among those who keep the weight off after dieting, more than nine in ten also exercise often. People who lose weight without working out tend to regain the pounds.

Check out the Exercise and Healthy Eating eCard on eCards for Health and encourage someone you know to do the same.

Sources: National Weight Control Registry, Presiden'ts Council on Physical Fitness and Sports

Office Staff
Provider Reference Manual updates
The Blues Provider Reference Manual on our website is updated throughout the year. Any updates that have occurred so far this year are located in the Table of Contents with Changes and Updates Preface page. Please note that these changes might not be current in the print and CD ROM versions; always refer to for the most current information.

Reimbursement for interpreter services
Some patients may need an interpreter while visiting your office. Contracted providers will need to provide an interpreter for limited-English-proficient individuals and interpretative services for patients who qualify under the Americans with Disabilities Act (ADA). Providers can arrange to use an interpreter service of their choice. Once the service is provided, the provider may submit an invoice for reimbursement to:

Provider Servicing
1205 N. Loop 340
Lacy-Lakeview, TX 76705

Providers who have joined or left the BCBSNM network, October 2011

Inpatient pediatric unit coming to Lovelace Westside Hospital in early 2012
Lovelace Westside Hospital's new Inpatient Pediatric Unit will serve pediatric patients who need to stay overnight for conditions such as:

  • Respiratory illnesses, such as respiratory syncytial virus (RSV), bronchitis, pneumonia, or influenza
  • Outpatient surgeries such as tonsillectomies
  • Other medical conditions that require overnight monitoring

The unit will have pediatric hospitalist coverage 24 hours a day, seven days a week. This will be the only inpatient pediatric unit servicing Albuquerque's west side and Rio Rancho

Ideas 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

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