June 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
Do we have your correct information?
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. Sleep Study Medical Policy Update
Previously, we notified you of revisions to the Blue Cross and Blue Shield of New Mexico (BCBSNM) Medical Policy, Diagnosis and Medical Management of Sleep Related Breathing Disorders (MED205.001). The updated policy is effective for services rendered on or after May 1, 2015.
View full story 2013 HEDIS® Initiation and Engagement of Alcohol and Other Drug Dependence Results
As noted on the NCQA website, the Healthcare Effectiveness Data and Information Set (HEDIS) is a tool used by more than 90 percent of health plans in the U.S. to measure performance on important areas of care and service. Collectively, HEDIS consists of 75 measures across eight categories of care.*
View full story Clinical Practice Guidelines Update
Recognizing that practitioners are busy, we have designed Clinical Practice Guidelines (CPGs) as quick summaries. CPGs summarize national, evidence-based recommendations that are appropriate for most patients with the condition. The CPGs have been reviewed by practicing New Mexico physicians and are meant to serve as general guidelines. They are not intended to substitute for clinical judgment in individual cases. Certain elements within a given CPG will be measured to determine the extent to which our members are receiving evidence-based care. We monitor these elements annually as part of Quality Improvement. CPGs are incorporated into our Blue Care Connection® Condition Management programs. These CPGs are available in PDF form as a free download for personal, noncommercial use in the Clinical Resources section of our website. We encourage you to access the full guidelines, as they provide in-depth coverage of the management of these common illnesses.
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 Provider Reference Manual Updates
The BCBSNM Provider Reference Manual on our website is updated throughout the year. Any updates that have occurred so far this year are located in the Table of Contents with Changes and Updates Preface page. 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. Third-Party Premium Payments
The BCBSNM Provider Reference Manual has been updated to include the following language:
View full story Using ICD-10 in Online Benefit Preauthorization Requests
BCBSNM will be offering educational webinars in the upcoming months to demonstrate the differences you may encounter when using ICD-10 codes in iExchange®, our online benefit preauthorization tool. Select a date from the list below to register now for an iExchange ICD-10 Enhancements webinar. June 10, 2015 – 10 to 11 a.m., MT
July 22, 2015 – 1 to 2 p.m., MT
Aug. 12, 2015 –10 to 11 a.m., MT Please note that the fact that a guideline is available for any given treatment, or that a service has been preauthorized/pre-certified is not a guarantee of payment. Benefits will be determined once a claim is received and will be based upon, among other things, the member’s eligibility and the terms of the member’s certificate of coverage applicable on the date services were rendered. ICD-10: Put Your Claims to the Test
It’s time to face the facts: The transition to ICD-10 is happening, there’s a lot you need to do to prepare and no one can do it for you. BCBSNM is nearing completion of updates to all applicable systems in preparation for the wide variety of scenarios that may occur related to processing of ICD-10 codes. Testing is critical to help identify possible issues so they can be fixed well before the Oct. 1, 2015, ICD-10 compliance date. If you are interested in testing your electronic claims with us, please contact your assigned Provider Network Specialist. Or, send an email to icd@bcbsnm.com – please include “ICD-10 TESTING REQUEST” in the subject line of your email. Provider ICD-10 testing at BCBSNM started in May 2015 and we want to start testing with you. HOW WILL ICD-10 IMPACT YOUR PRACTICE?
The transition to ICD-10 is huge! It will affect all aspects of your practice. For a visual representation of the potential impact to various departments in a provider office, refer to the Provider Office Changes Map. Also visit the ICD-10 page in the Standards and Requirements section of our website for additional information and related resources. |
Claim Status No Longer Available through Automated Phone System, Effective July 13, 2015
As noted in last month’s Blue Review and also on our Provider website, effective July 13, 2015, claim status will no longer be available via the BCBSNM Interactive Voice Response (IVR) phone system. BCBSNM Customer Advocates will remain available to assist your office with claim adjustments; however, document control numbers (DCNs) – claim numbers – will be required.
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Providers Who Have Joined or Left the BCBSNM Network, April 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?
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. 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 | 