Issue 10, 2009
BCBSNM ranks high in customer service, claims processing satisfaction
BCBSNM participates annually in the Consumer Assessment of Healthcare Providers and Systems (CAHPS®1) Survey. The overall objective of the CAHPS study is to capture accurate and complete information about consumer-reported experiences with health care. In 2008, the National Council for Quality Assurance (NCQA) collected CAHPS results from 168 commercial PPO plans nationwide and found that BCBSNM ranks in the top 3 percent of PPO plans for customer service satisfaction and in the top 1 percent for claims processing satisfaction. Our Customer Advocates (CAs) resolve 92 percent of inquiries during the initial phone call with an average answering speed of 26 seconds. Claims Examiners process more than 98 percent of claims within 14 calendar days of receipt, with accuracy rates that consistently exceed 99 percent.
1CAHPS® is a registered trademark of the Agency for Healthcare Research and Quality.
H1N1 flu update
BCBSNM continues to closely monitor the H1N1 flu situation and, as needed, will provide updates about any potential impact the H1N1 flu will have on the services we provide to members. BCBSNM is ready to respond if the outbreak significantly impacts any of our service areas.
Our members’ medical benefits may vary by employer group, plan, and type of coverage (e.g., PPO, HMO, HSA). The plan’s benefits determine where members should go to be tested and treated, what portion of their care is paid for, and which medications and tests are covered.
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.
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New guidelines available on use of medications in the elderly
The New Mexico Prescription Improvement Coalition (NMPIC) recently issued a clinical recommendation titled “Medications to Be Used with Caution in the Elderly.” A consensus panel of health care providers, including pharmacists, geriatric providers, and managed care specialists developed this recommendation. The group evaluated nationally published lists of potentially inappropriate medications and criteria to develop a statewide recommendation, which includes alternative suggestions for each medication.
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Pharmacy updates: FDA considers new warnings, changes to acetaminophen products
In June 2009, the FDA addressed the continuing public health problem of liver injury related to the misuse of acetaminophen in both over-the-counter (OTC) and prescription products.
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Not-Otherwise-Classified J codes: Correction to July article
In the July issue, we ran an article on the use of J codes. There is a correction to the note at the end of the article. The July article stated, “Please note: An NDC [National Drug Code] number can only be used for a maximum of two years, after which time it becomes obsolete.” Following is the corrected statement:
Please note: An NDC number will be reimbursed for a maximum of two years after it becomes obsolete.
Office Staff
How to bill electronically for unlisted drug and injection procedure codes
Providers often file unlisted procedure codes on paper claims to include the descriptions of the services rendered. The electronic format system, however, includes a descriptive field for each line of service, allowing providers to include the description. This helps reduce the unnecessary filing of paper claims.
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Taxonomy codes – definition and claims use
Taxonomy codes are administrative codes set for identifying the provider type and area of specialization for health care providers. Each taxonomy code is a unique ten-character alphanumeric code that enables providers to identify their specialties at the claim level. Taxonomy codes are assigned at both individual provider and organizational provider levels.
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Helpful tips for preventing claim delays
Filing corrected claims
BCBSNM has separate procedures for filing corrected claims, depending on whether the member has BCBSNM or Medicare as his or her primary insurance.
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Duplicate claims are costly for providers, insurance carriers
Every time duplicate claims are filed, they must be processed, which can be counterproductive in many ways.
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Electronic payment summary (EPS) reminders
One of the benefits of enrolling in the electronic remittance advice (ERA) is that you automatically receive the EPS. The EPS contains the same information as the paper provider claim summary (PCS), but you’ll receive your payment information sooner, and it is easier to archive.
New ERA/EPS enrollees will continue to receive a paper PCS for 30 days after they start receiving their ERA and EPS files. This 30-day transition period is designed to help providers switch from paper to electronic files. When the transition period ends, the PCS will be discontinued, and providers will begin to receive only the EPS.
If you enrolled for ERA/EPS directly or through your clearinghouse/billing agent more than a month ago, you may have continued to receive both the ERA and the PCS in your office for more than 30 days. Please be advised that your PCS will now be discontinued. Going forward, you will receive only the EPS.
Join the e-commerce movement!
Since January 2009, BCBSNM has seen a 204 percent increase of enrollment in our electronic funds transfer (EFT), electronic remittance advice (ERA), and electronic payment summary (EPS) programs compared to our enrollment for all of 2008. If you want to take advantage of these services, visit the Electronic Commerce section of our website, where you can access enrollment forms and view answers to frequently asked questions about EFT, ERA, and EPS. If you need additional assistance, please contact our Electronic Commerce Center at 800-746-4614.
Providers who have joined the BCBSNM network, August 2009
Blue Medicare PPO SM
Medicare Advantage (MA) fraud, waste, and abuse training requirements
In issue 7, we provided basic information about MA provider fraud, waste, and abuse (FWA) training. You will be pleased to know that because of a collaborative effort among BCBSNM, BCBSTX, Presbyterian Health Plan, Presbyterian Insurance Company, and Lovelace Health Plan, a new centralized training presentation is being offered to streamline the process for our providers.
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BlueSaludSM
Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Program
EPSDT is a federally mandated program ensuring comprehensive health care to Medicaid recipients from birth to 21 years of age.
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Family planning services for BlueSalud members
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.
