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Blue Cross and Blue Shield of New Mexico

February 2016

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. Additionally, the Centers for Medicare & Medicaid Services require Blue Cross and Blue Shield of New Mexico (BCBSNM) to make sure that our online Provider Finder® and provider directory are kept current with our provider demographic information. 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.

Be sure to visit us online at bcbsnm.com/provider to access the most updated information.

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 Medicare Enrollment Information
An enrollment information message from the Centers for Medicare & Medicaid Services (CMS) may have been sent to you recently if you currently prescribe drugs to Medicare patients but are not enrolled in (or validly opted out of) Medicare. A new requirement that CMS will begin enforcing on June 1, 2016, requires that all providers who prescribe drugs for Part D patients must enroll in Medicare (or validly opt out, if appropriate). This is important to providers because unless you enroll (or validly opt out), Medicare Part D plans will be required to notify your Medicare patients that you are not able to prescribe covered Part D drugs. Please also note that if you opt out of Medicare, you cannot receive reimbursement from traditional Medicare or a Medicare Advantage plans, either directly or indirectly (except for emergency and urgent care services; see 42 CFR 405.440 for details.) Please refer to the CMS letter on bcbsnm.com/provider for more information on this requirement for enrollment (or to validly opt out). CMS contact information is also included in the letter if you have questions regarding this regulation.

New Products Offer More Choices and Potential Savings for BCBSNM Members
Our growing selection of new product offerings reflects Blue Cross and Blue Shield of New Mexico’s (BCBSNM’s) commitment to increasing access to affordable, quality health care services for our members. Blue Preferred EPOSM and Blue Preferred PlusSM are two new products that will offer a unique approach for members who prefer more flexibility when choosing a provider. These products will be available in 2016, and are currently being marketed in the following Albuquerque area counties: Bernalillo, Sandoval, Torrance and Valencia. View full story

HEDIS® Medical Record Review Requests
The National Committee for Quality Assurance (NCQA) and the U.S. Department of Health and Human Services (HHS) require an NCQA-certified auditor to perform an annual Healthcare Effectiveness Data and Information Set (HEDIS) audit of Blue Cross and Blue Shield of New Mexico’s (BCBSNM’s) health plan quality performance. 
View full story

ICD-10 ‘Coding Basics’ Video and Other Resources
While it may take time for providers, payers, clearinghouses and other vendors to adjust completely, it appears that the national transition to ICD-10 has been largely successful.

The Centers for Medicare & Medicaid Services (CMS) continues to release educational resources for providers, such as a recent video titled, “ICD-10 Post-Implementation: Coding Basics Revisited.” This video covers such points as the CMS definition of a valid code, basic guidelines for coding and reporting on claims, as well specific examples (7th character, unspecified codes, external cause codes, laterality, etc.) and information on resources for coders. The 33-minute video features American Health Information Management Association (AHIMA) Senior Director of Coding Policy and Compliance Sue Bowman, MJ, RHIA, CCS, FAHIMA, and Nelly Leon-Chisen, RHIA, from the American Hospital Association (AHA).

The Coding Basics Revisited video may be accessed via the CMS website. For your convenience, a link to the video also is posted in the Standards and Requirements/ICD-10 section of our website at bcbsnm.com/provider. You’ll also find links to other ICD-10 resources on our Provider website, such as updated answers to frequently asked questions.

This material is for educational purposes only and is not intended to dictate what codes should be used in submitting claims. Health care providers are instructed to use the most appropriate codes based upon the medical record documentation and coding guidelines.

Providers Who Have Joined or Left the BCBSNM Network, January 2016
This list reflects contracted providers for all lines of BCBSNM business: Commercial, Medicaid managed care, and Medicare Advantage Prescription Drug (MAPD). 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.

Reduction in Prior Authorization Requirements
Blue Cross and Blue Shield of New Mexico (BCBSNM) is pleased to announce that we have significantly reduced the prior authorization requirements for Blue Cross Community Centennial members effective January 1, 2016. This reduction in the prior authorization requirements is a reflection of our continuous efforts to ease the administrative burden on our contracted health care providers and addresses an area of opportunity for improvement from our most recent provider satisfaction survey results. The full list of Blue Cross Community Centennial services requiring prior authorization is available on our website at bcbsnm.com/provider.

Advance Directives – Not Just a Good Idea
Pursuant to the Patient Self-Determination Act of 1991, discussing advance directives with your patients isn’t just a good idea, it’s a federal regulation—competent individuals must be advised of their right to execute advance directives. This is one reason why we require our primary care providers (PCPs) to document discussion of advance directives in medical records for members 18 years old or older. Another is the trusting relationship between our PCPs and members. View full story

Get Ready, HEDIS® 2016 Starts Now!
Annual HEDIS 2016 medical record requests go out this month. Blue Cross Community Centennial providers whose practices have seen more than ten Medicaid members and are part of our sample will hear from a HEDIS reviewer soon and be given the option of setting up an on-site record review. Blue Cross Community Centennial providers who have seen fewer than ten sampled Medicaid members will receive a fax request with instructions to return records by email, fax, or mail. 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 and Blue Shield of New Mexico is committed to the highest standards of business ethics and integrity as well as strict observance and compliance with the laws and regulations governing its business operations.

A Division of Health Care Service Corporation, a Mutual Legal Reserve Company,
an Independent Licensee of the Blue Cross and Blue Shield Association.

P.O.Box 27630, Albuquerque, NM 87125-7630

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