February 2015 Please distribute this newsletter, which contains claims, billing, Medical Policy, reimbursement, and other important information, to all health care providers, administrative staff, and billing departments/entities that this email address represents.
You can find Blue Review online! Ideas for articles and letters to the editor are welcome; email NM_Blue_Review_Editor@bcbsnm.com
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Maintaining up-to-date contact and practice information helps to ensure that you are receiving critical communications and efficient reimbursement processes. Please complete our quick and easy online form if you have: - Moved to another location
- Left a group practice
- Changed your phone number
- Changed your email address
- Retired
- Any other changes to your practice information
Medical Policy Updates
Approved new or revised Medical Policies and their effective dates are usually posted on our website the first and fifteenth of each month. These policies may impact your reimbursement and your patients’ benefits. On our website, you may view active, pending and updated policies and/or view draft policies and provide comments. The policies are located under the Standards & Requirements tab at bcbsnm.com/provider.
Keep Up-To-Date With the Latest News and Updates!
Along with all the valuable information included in our Blue Review newsletter, the News and Updates section of our website gives the latest updates in webinar schedules, current programs, and policies. The eCommerce Alerts section provides notification of system enhancements, upgrades, new functionality, and any Electronic Data Interchange (EDI) transaction issues that may affect claims processing, payment, or remittance delivery. We periodically update the forms on our provider website, so it’s important to check often to help ensure you are using the most current version. Forms are organized by category in our Education and Reference section. Commercial Drug List Updates Reminder: Insulin Formulary Changes and New Prior Authorization Program for 2015
Starting Jan. 1, 2015, for non-Medicare Part D or Medicaid members with Blue Cross and Blue Shield of New Mexico (BCBSNM) prescription drug coverage, Novolin, Novolog, Lantus and Levemir are preferred insulin brands and process at the member’s preferred brand copay. Humulin and Humalog are non-preferred brands, and in most cases depending on the member's benefit plan, will require a prior authorization request to be submitted and approved for coverage consideration. See the News & Updates article published on Jan. 14, 2015 for more information. Annual HEDIS® Medical Record Extraction Begins February 1, 2015
It’s that time of the year when the BCBSNM HEDIS team may be contacting your office or facility in preparation for the gathering of information for the nationally validated Healthcare Effectiveness Data and Information Set (HEDIS).
View full story 2014 HEDIS Antidepressant Medication Management Results
HEDIS is a tool used by more than 90% of America's health plans, and it measures performance on important dimensions of care and service, including Behavioral Health. Because so many plans collect HEDIS data and the measures are so specifically defined, HEDIS makes it possible to compare performance among health plans.
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Telehealth Supports Providers with Behavioral Health Services
Ensuring underserved residents throughout rural areas of New Mexico have access to behavioral health services can be challenging. The psychiatrist to population ratio is 1:21,276 in rural areas in contrast to the 1:2,970 ratio for those residing in urban areas. Technology is helping bridge the gap, thus eliminating long commutes for rural area residents to see providers. Telehealth services allow patients to stay in their community while receiving the help and services they need.
View full story Urine Drug Testing Policy, Effective Dec. 15, 2014
BCBSNM Medical Policy MED207.154 (Urine Drug Testing Including Pain Management and Substance Abuse Monitoring) became effective Dec. 15, 2014. This new policy addresses the overutilization of quantitative/confirmatory urine drug testing as a routine screening tool. With few exceptions, this policy prohibits the routine use of quantitative/confirmatory testing as being not medically necessary. The most prominent exception being when a patient tests positive on a qualitative test and the physician determines it is medically necessary for treatment decisions to know the quantity of the drug in the patient’s system.
View full story New Effective Date for Sleep Study Medical Policy Updates
In our January 2015 issue of Blue Review,we included an article titled, “Diagnosis and Medical Management of Sleep Related Breathing Disorders,” announcing medical policy revisions that will be effective for dates of service beginning April 15, 2015. The new effective date for this medical policy change is now extended to May 1, 2015.
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Compound Medications May Warrant Dose of Caution
Pharmacy compounding is the practice of combining, mixing, or altering ingredients of a drug to create a customized medication for a particular patient, if warranted, based on the patient’s individual health needs. For example, a compound drug may be necessary to help avoid allergic reactions; or the dosage form may need to be changed to a liquid for a child or other patient due to the patient’s inability to swallow a pill. Compounding does not include mixing or reconstituting commercial products in accordance with the manufacturer’s instructions or the product’s labeling.
View full story Legislative Update: Expedited Formulary Exception Process for Exigent Circumstances
On May 27, 2014, the Department of Health and Human Services issued a final regulation entitled, Patient Protection and Affordable Care Act; Exchange and Insurance Market Standards for 2015 and Beyond.
View full story Anthem® Blue Cross and Blue Shield Introduces Cancer Care Quality Program
Effective Jan. 1, 2015, Anthem Blue Cross and Blue Shield implemented a Cancer Care Quality Program administered through AIM Specialty HealthSM (AIM). While this program is not applicable to other Blue Plan members, we are sharing information about this program since it is offered to both national and local Anthem members. This innovative quality initiative is an evidence-based cancer treatment program designed to support provider decision making as it relates to selecting cancer treatment regimens that are consistent with current evidence and consensus guidelines. These Cancer Treatment Pathways (Pathway) have been developed based on medical evidence and best practices from leading cancer experts to support oncologists to identify therapies that are highly effective and affordable. Claim information collected may help identify members for Anthem’s Case Management programs which may result in maximizing the impact to the patients’ overall health. Additional information about this program can be found on AIM’s website at: http://www.aimspecialtyhealth.com/solutions/clinical-specialties/oncology. Anthem® is a registered trademark of Anthem Insurance Companies, Inc. The information mentioned here is for informational purposes only and is not a substitute for the independent medical judgment of a physician. Physicians are instructed to exercise their own medical judgment. Members should refer to their certificate of coverage for more details, including benefits, limitations and exclusions. Office Staff 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. Network Services contacts and related service areas Network Services regional map
ClaimsXtenTM Updates – 1st Quarter 2015
BCBSNM reviews new and revised Current Procedural Terminology (CPT®) and HCPCS codes on a quarterly basis. Codes are periodically added to or deleted from the ClaimsXten software by McKesson and are not considered changes to the software version. BCBSNM normally loads this additional data to the BCBSNM claim processing system within 60 to 90 days after receipt from McKesson and will confirm the effective date on the BCBSNM Provider website. Advance notification of updates to the ClaimsXten software version (i.e., change from ClaimsXten version 4.1 to 4.4) will continue to be posted on the BCBSNM Provider website.
View full story Providers Who Have Joined or Left the BCBSNM Network, December 2014
This list reflects contracted providers for all lines of BCBSNM business: Commercial and Medicaid managed care.
View full story Blue Cross Community CentennialSM (Medicaid) Not yet contracted?
Blue Cross and Blue Shield of New Mexico’s (BCBSNM’s) Medicaid plan is Blue Cross Community Centennial. Providers who are participating in commercial BCBSNM products are not automatically participating providers in Blue Cross Community Centennial. To become a Blue Cross Community Centennial provider, you must sign a Medicaid amendment to your Medical Services Entity Agreement (MSEA). If you have any questions please call 505-837-8800 or 1-800-567-8540 if you are interested in becoming a Blue Cross Community Centennial provider.
Reminder: Update Your Enrollment Information
Due to Centennial Care requirements, all enrollment information (changes to demographics, licensure or certification, provider status, etc.) must be updated on the NM Medicaid Provider Web Portal. Medicaid Drug List Updates Free Continuing Education!
Diabetes continuing education is available for you and your staff; links to free professional development opportunities are now on the BCBSNM provider website under Clinical Resources/Diabetes Guidelines. Current webinars/webcasts from the American Diabetes Association include “Diabetes is Primary” which offers up to 8.25 continuing education credits. Select one or more topics in the module, such as “Treatment Algorithms”, “Diabetes Survival Skills”, and “Tough Cases”. Self-Assessment programs include, “Management of Hyperglycemia in Type 2 Diabetes: A Patient-Centered Approach” and “Diabetes and the Older Adult” for up to 4.75 continuing education credits. The latest information on diabetes and its complications, practical tips and proven strategies for improving patient care and translation of the latest diabetes research into clinical practice can be found by using the above link on the BCBSNM provider website. Such services are funded in part with the State of New Mexico. Blue Cross and Blue Shield 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 | 