May 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. Commercial Drug List Updates Women’s Contraceptive Drug List Reminder
Under the Affordable Care Act (ACA), certain U.S. Food and Drug Administration (FDA) approved women’s contraceptives are covered with no member cost share when in-network providers and pharmacies are used. The list of women's contraceptives covered by Blue Cross and Blue Shield of New Mexico (BCBSNM) for eligible benefit plans was updated this year to include dosage strengths for some drugs. Eligible members with prescription drug coverage through Prime Therapeutics may find the Women’s Contraceptive Drug List in the Member Services/Prescription Drug Plan section of our website at bcbsnm.com. If members have questions, they may contact the number on the back of their ID card for assistance. Prime Therapeutics LLC is a pharmacy benefit management company. BCBSNM contracts with Prime to provide pharmacy benefit management, prescription home delivery and specialty pharmacy services. BCBSNM, as well as several other independent Blue Cross and Blue Shield Plans, has an ownership interest in Prime. The information mentioned here is for informational purposes only and is not a substitute for the independent medical judgment of a physician. Members should refer to their certificate of coverage for more details, including benefits, limitations and exclusions. Regardless of benefits, the final decision about any medication is between the member and their health care provider. Join Us for an iExchange® Webinar
BCBSNM continues to enhance iExchange, our Web-based benefit preauthorization tool. iExchange supports online submission and electronic approval of benefits for inpatient admissions and select outpatient services such as pharmacy and behavioral health. This flexible tool enables you to send benefit preauthorization requests 24 hours a day, 7 days a week and provides real-time responses.
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FDA Reclassifies Select ADHD Generic Drugs
In November 2014, the U.S. Food and Drug Administration (FDA) announced a classification change for methylphenidate hydrochloride extended release tablets manufactured by Mallinckrodt and Kudco. According to the FDA, these drugs are no longer considered to be generic equivalents for the Janssen-manufactured brand drug Concerta, a treatment for Attention Deficit Hyperactivity Disorder (ADHD) in adults and children. This change resulted from a post-marketing data analysis that showed these drugs do not provide the same therapeutic effect as Concerta.*
View full story Prescribing Off-Label Drug Therapies
BCBSNM generally excludes coverage of medications that are not FDA approved. Common examples of off-label drug therapies are:
View full story NEW! Videos on Patient Support and Palliative Care - What Every Physician Should Know
BCBSNM is expanding its efforts to encourage early member referrals to palliative care by releasing two new videos on the topic. The videos feature Martha L. Twaddle, MD, FAAHPM who has helped to facilitate the growth and development of palliative and hospice care on the national level.
View full story Demonstrating our Commitment to BCBSNM Communities
BCBSNM is pleased to share our 2014 Social Responsibility Report. This year’s report captures the passion and commitment that our employees exhibited in 2014 as they worked to make a difference in their communities. Through personal stories and compelling videos, this report highlights the efforts BCBSNM employees made in:
View full story 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
Claim Status Availability to Change in Automated Phone System
Effective July 13, 2015, claim status requests will no longer be available within the BCBSNM Interactive Voice Response (IVR) phone system. You may continue to use the IVR phone system to obtain eligibility and benefits information and Customer Advocates will remain available for other inquiries, such as claim adjustments.
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BlueCard® Program Makes Filing Claims Easy
BlueCard is a national program that enables members of one Blue Plan to obtain health care service benefits while traveling or living in another Blue Plan’s service area. The program links participating healthcare providers with the independent Blue Plans across the country and in more than 200 countries and territories worldwide through a single electronic network for claims processing and reimbursement.
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ClaimsXtenTM System Edit Updates, Effective June 2015
Beginning on or after June 15, 2015, BCBSNM will enhance the ClaimsXten code auditing tool with the following changes to the bundling logic in our claim processing system:
View full story CMS Replaces Modifier 59 with New ‘X’ Modifiers
Effective Jan. 1, 2015, the Centers for Medicare & Medicaid Services (CMS) added four new modifiers to replace modifier 59 when submitted with Current Procedural Terminology (CPT®)/HCPCS codes. Modifier 59 was previously used to report that a service was a distinct procedural service. Following are the new modifiers replacing modifier 59 and their descriptions:
View full story ICD-10: Be a Part of the Solution
ICD-10-CM diagnosis codes will be required on all professional and outpatient claims with dates of service on or after the compliance date of Oct. 1, 2015, as established by the U.S. Department of Health and Human Services (HHS). Both ICD-10-CM diagnosis and ICD-10-PCS procedure codes will be required on all inpatient institutional claims with discharge dates on or after Oct. 1, 2015. Service dates or discharge dates prior to Oct. 1, 2015, will require ICD-9 codes. Use of other codes, such as CPT, HCPCS and Revenue Codes will not be impacted by this change.
View full story Providers Who Have Joined or Left the BCBSNM Network, March 2015
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?
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 Medicaid Reminders
Federal requirements for Medicaid health plans specify that certain benefits and services be available to Medicaid members. These include:
View full story Member Benefit for Smoking Cessation Drugs
Blue Cross Community CentennialSM provides coverage for smoking cessation drugs, with preauthorization. A preauthorization ensures that members are enrolled in a smoking cessation program. Smoking cessation programs, by themselves and in combination with drug therapy, have been proven to increase the likelihood of success1.
Blue Cross Community Centennial members may enroll in ANY smoking cessation program. However, if a member has not enrolled in a program at the time that the preauthorization is requested, they will be directed to the Blue Cross Community Centennial Smoking Cessation program. The Blue Cross Community Centennial Smoking Cessation team can be reached at: 505-816-2922, 505-816-2757 or 877-232-5518. - Clinical Practice Guideline: Treating Tobacco Use and Dependence: 2008 Update, U.S. Department of Health and Human Services, Public Health Service
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. EPSDT is defined as:
View full story 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 Blue Cross Medicare AdvantageSM Medicare Resources
The Blue Cross Medicare AdvantageSM Plans offer all of the coverage of Original Medicare — plus benefits not covered by Medicare or most Medicare Supplement insurance plans, including built-in prescription drug coverage.
View full story Blue Cross Medicare Advantage and Blue Cross Medicare Advantage Dual Care plans are HMO, HMO-POS, PPO, and HMO Special Needs Plans provided by Health Care Service Corporation, a Mutual Legal Reserve Company (HCSC), an independent licensee of the Blue Cross and Blue Shield Association. HCSC is a Medicare Advantage organization with a Medicare contract and a contract with the New Mexico Medicaid program. Enrollment in HCSC’s plans depends on contract renewal. | 