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 entities. Many issues contain articles relevant to their jobs. Our goal is to provide you with the most current and reliable information that can increase provider satisfaction and help reduce administrative costs.
Some of the information you and your billing entities can find in Blue Review includes: system and coding updates, billing and reimbursement, new account groups, federal mandates, innovative health care products and services, medical management initiatives, and electronic commerce solutions.
Free online CME for diabetes management The New Mexico Department of Health (DOH) Diabetes Prevention and Control Program has recently released two high-quality online courses related to the management of diabetes: Diabetes and Depression and Diabetes and Smoking.
These practical courses are designed for clinicians caring for people with diabetes. They provide free Continuing Medical Education (CME) credits for physicians and continuing education credit for other licensed providers. Each training course is evidence-driven and contains references.
“I took the courses myself and believe they offer useful guidance for physicians and other health professionals,” said Bruce A. Mann, MD, BCBSNM Medical Director for Quality Improvement and statewide Chair of the Steering Committee for New Mexico Health Care Takes On Diabetes. “Plus, given the high price of CME these days, free CME is appreciated.”
BCBSNM encourages you to look at what the DOH offers by going to the DOH Diabetes website and selecting one of the above courses under the heading Online Courses (free CMEs).
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 Medical Policy information. If you have any questions about BCBSNM’s Medical Policies, please call Health Services at (505) 816-2093.
Eff. Date
Policy No.
Policy Name
6/1/10
SUR713.001
Refractive and Therapeutic Keratoplasty
6/15/10
RAD605.001
Positron Emission Tomography (PET)
6/15/10
ADM1001.026
Multivariant Analysis of Patient-Specific Findings
7/1/10
THE801.033
Phototherapy for Dermatologic Conditions
Drug List updates The BCBSNM Prime Therapeutics® Pharmacy and Therapeutics Committee met on February 22, 2010, and recommended the following changes to the BCBSNM Drug List. View full story
Pharmacy update: Generic drug controversy Generic drugs now account for 70 percent of all prescriptions in the United States. Health plans, third-party payors, and pharmacy benefit managers promote these less-costly bioequivalent medications as a way to reduce health care costs and to facilitate patient access to important treatments. At the same time, generics represent only about 18 to 20 percent of total health care expenditures for pharmaceuticals. View full story
Electronic health record now offered via Availity® CareProfile® free of charge Created with collaborative input by BCBSNM, MEDecision®, and Availity, the CareProfile (ACP) is a user-friendly electronic health record (EHR) that assists health care professionals in making informed treatment decisions for their patients. View full story
Provider education webinars available
BCBSNM offers complimentary educational webinar sessions to our provider community. Some of the current training modules are:
American Imaging Management (AIM)/Radiology Quality Initiative (RQI)
Member rights and responsibilities Our health plan members have rights and responsibilities that are listed in their Benefit Booklet or Member Handbook. Some members – for example, members with BlueDirect® and BlueEdgeSM plans – can also find these documents in the member section of our website.
Office Staff Medicare Advantage electronic claim rejection alert Blue Medicare PPOSM Medicare Advantage claims transmitted electronically to BCBSNM will now be rejected. Submitters will receive a three-digit/alpha error code with this message on their response report(s): 4EL>Claim must be submitted to payer “NMPPO.” This applies to professional and institutional claims. You can easily identify Medicare Advantage members by the YID alpha prefix at the beginning of their BCBSNM member ID numbers.
If you use a billing agent and/or clearinghouse, please ensure that they are aware and responsive to this and other messages specified on the response report(s) you currently receive.
If you have any questions about this notification, call our Electronic Commerce Center at 800-746-4614.
Billing correctly for physical, occupational, and speech therapy services It is not within the scope of practice for physical, occupational, and/or speech therapy providers to bill for medical examination (office visit) Current Procedural Terminology (CPT®) codes. Such CPT codes are designed for evaluation and management of an injury or illness. If an evaluation is being performed for physical, occupational, or speech therapy, there are appropriate therapy evaluation CPT codes available that are designed for evaluation of therapy-related injuries and/or illnesses.
For a list of appropriate therapy evaluation procedure codes, please refer to your CPT manual or contact the American Medical Association Unified Service Center at 800-621-8335.
Providers who have joined or left the BCBSNM network, March 2010 This list reflects contracted providers for all lines of BCBSNM business: Commercial and Medicaid managed care (BlueSaludSM). All providers are contracted for commercial and BlueSalud unless indicated otherwise. View full story
BlueSalud BlueSalud primary care physician responsibilities BlueSalud PCP responsibilities will include the following, per MAD-MR: 07-10, 8.305.6.12 View full story
Referring BlueSalud members for behavioral health services The following are common indicators for a referral to OptumHealthSM New Mexico for behavioral health services or for a referral directly to a behavioral health provider by a PCP. View full story
Electronic claims transmission (ECT) requirements for BlueSalud providers In accordance with the New Mexico Human Services Department (HSD) regulations, contracted practitioners and providers are required to file claims electronically for their Salud! and State Coverage Insurance (SCI) membership.
ECT can save your office staff time, money, and resources by making the claims process more efficient. In addition, ECT offers:
Quicker confirmation of claims receipt and integrity of data
Higher percentage of claims accuracy, resulting in faster payment
Formatting of claims data into the HIPAA-required ANSI-X12 837 claims format
A Provider Services representative from BCBSNM may be contacting your office soon in person or by phone to obtain feedback about any barriers your office may be facing regarding this requirement. If you have any questions, please contact BCBSNM Network Services at (505) 837-8800 or 800-567-8540.
