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.
Issue 12, 2009
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 comment.
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Don’t let your patients fall through the cracks
Each year, BCBSNM analyzes data for ways to improve coordination of patient care. Any clinician working in health care today has seen the suffering and cost created when patients “fall through the cracks” of coordinated care.
This year, we surveyed 1,500 professionals in our network to determine where the greatest opportunities lie. The findings were reviewed quantitatively and qualitatively by the physicians and other clinicians on the Quality Improvement Professional Review Committee. Three issues rose to the top.
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Seasonal influenza vaccination reminder
Seasonal influenza vaccination is cost-effective but under-utilized. Since seasonal influenza vaccination has been shown to be highly effective in reducing the morbidity and mortality of influenza, improving the influenza vaccination rate should have a positive impact on your patients.
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Behavioral health authorizations expire December 31, 2009
Please remember that all BCBSNM outpatient psychotherapy and medication management authorizations expire on December 31, 2009. You will need to obtain a new authorization prior to January 1, 2010.
To get a new 2010 authorization, please call 800-325-8334 and select option 2, then option 4.
Federal Employee Program (FEP): Prior approval is required for all outpatient and inpatient behavioral health and substance abuse care (preferred and nonpreferred providers). Exceptions: Pharmacotherapy/medication management (CPT code 90862 only) and psychological testing. If you fail to obtain prior approval for these services, they will not be covered under the member’s benefit plan.
New fax number for prescription drug prior authorizations
BCBSNM has changed the fax number for its pharmacy prior authorization requests. The new number is (505) 816-3853. When you fax pharmacy prior authorization requests, please use the most current version of the prior authorization form and fax the form to the number above, to the attention of Pharmacy Services. This form is for both commercial and Medicaid health plan members.
The top 25 Medicare Part D formulary changes for 2009-2010
The 2010 BCBSNM Medicare Part D formulary, which has been approved by the Centers for Medicare & Medicaid Services (CMS), will be included in the Annual Notice of Change sent to our Medicare Part D plan members. Members also received letters in late November about the formulary changes. You can find a comprehensive 2010 formulary on our website.
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Gain the paperless advantage: Sign up for our electronic tools
Sign up to receive the Electronic Remittance Advice (ERA) and Electronic Payment Summary (EPS) and enjoy increased efficiency, accuracy, and security of your account reconciliation processes. Remember, even though you may not be submitting electronic claims yet, you can still enroll in ERA and EPS.
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Enhanced online tool provides cost information for most common medical procedures
BCBSNM believes an educated consumer will make better health care decisions. We’re excited to announce an enhancement to our Hospital Comparison Tool. Named Care Comparison®, this new component of the hospital transparency tool will allow members to make informed decisions when choosing a hospital or facility for common medical procedures and related services.
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Office Staff
Provider Reference Manual updates
We update our Blues Provider Reference Manual on our website throughout the year. Updates are listed in the Table of Contents with Changes and Updates Preface. Please note that these changes might not be current in the print and CD ROM versions; always refer to bcbsnm.com for the most current information.
Interactive Voice Response resources for you
The BCBSNM Interactive Voice Response (IVR) system is designed to deliver a more user-friendly, timely, and efficient caller experience. We have developed additional resources to assist callers in understanding this technology. The IVR Caller Guide walks callers through each question and advises when a caller should speak or use touch-tone options, and at which point a caller can opt to speak to a Customer Advocate. You can find all our IVR resources on our website.
Check out our provider education webinars
BCBSNM offers complimentary educational webinar sessions to our provider community. We offer a variety of education topics, allowing providers to choose specific topics that focus on their own practice or individual needs. Our provider education specialists are prepared to provide the personalized attention you have come to expect from BCBSNM.
Current available webinar topics:
- American Imaging Management (AIM)/Radiology Quality Initiative (RQI)
- Availity/Electronic Data Interchange (EDI)
- The bcbsnm.com site
- BlueCard®
- Coordination of Benefits (COB)
- Electronic Commerce
- Interactive Voice Response (IVR)
- National Provider Identifier (NPI)
For more information, please see our Provider Education Schedule or e-mail the webinar coordinator.
Providers who have joined the BCBSNM network, October 2009
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.
Blue Medicare PPOSM Transition Updates
Blue Medicare PPO provider portal unavailable after December 31
This is important information for Blue Medicare PPO providers who use the Blue Medicare PPO provider portal. Because BCBSNM has made the difficult decision to exit the Medicare Advantage Program after December 31, 2009, the Blue Medicare PPO provider portal will not be available after that date. After December 31, 2009, eligibility and claims status for Blue Medicare PPO members can be obtained by calling Customer Service at 866-706-7745.
BlueSaludSM
DoralTM Dental changes name to DentaQuest®
Effective December 1, 2009, Doral Dental USA, LLC, the dental benefits manager for BlueSalud members, will change its name to DentaQuest. The Doral website will also change to dentaquest.com effective December 1.
Not yet contracted for BlueSalud?
Providers who are participating in commercial BCBSNM products are not automatically participating providers in BlueSalud. To become a BlueSalud provider, you must sign a Medicaid amendment to your Medical Services Entity Agreement (MSEA). Please contact Angela Sanchez-Caldwell at (505) 816-2038 or by e-mail if you are interested in becoming a BlueSalud provider.
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.
