March 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 provider inquiries about many areas, including eligibility, benefits, and claim adjustments 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 Register Today for a ‘BCBSNM Back to Basics: AvailityTM 101’ Webinar
Blue Cross and Blue Shield of New Mexico (BCBSNM) will present ”BCBSNM Back to Basics: Availity 101”, a complimentary webinar covering the self-service electronic tools and features that can be accessed through the Availity Web portal. View full story Remittance Viewer Webinar Reminder
If you are looking for a faster, easier way to view your claim payment information from Blue Cross and Blue Shield of New Mexico (BCBSNM), we invite you to use remittance viewer, a convenient online tool. View full story BCBSNM Behavioral Health Quality Improvement Program
Blue Cross and Blue Shield of New Mexico (BCBSNM) is committed to improving our members’ experience and the value they receive from behavioral health care delivery. To meet these goals, BCBCNM identifies, monitors and evaluates clinical and service improvement opportunities through the Behavioral Health Quality Improvement (BHQI) program. View full story BCBSNM Announces Impressive Results of Pediatric Asthma Intervention Project
Blue Cross and Blue Shield of New Mexico (BCBSNM) and the American Lung Association in New Mexico are announcing this week the initial results of a three-year collaboration, the “Enhancing Care for Children with Asthma” project. View full story Infusion Site of Care Management Program to Target Select BCBSNM Members
Blue Cross and Blue Shield of New Mexico (BCBSNM) is working with Coram® CVS/Specialty Infusion Services (Coram) to identify members* who may benefit from hearing about Coram’s infusion care services. These services can be offered in the member’s home, at a Coram infusion suite, or select CVS/pharmacy® locations. View full story Providers Who Have Joined or Left the BCBSNM Network, Feburary 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 www.bcbsnm.com/provider.
Telemedicine Reimbursement
Please note, this is a correction to the November 2015 BCBSNM Blue Review article, “Additional Reimbursement Available for Telehealth/Telemedicine Services.” Blue Cross and Blue Shield of New Mexico (BCBSNM) supports and encourages the use of telemedicine capabilities in order to improve access to and quality of care. Providers caring for BCBSNM Blue Cross Community Centennial Medicaid members that utilize telemedicine services as part of that care, may bill a Q3014 code on the professional claim form (in addition to any other E&M codes for services provided). In order to bill the Q3014 code, the patient must be present.1 Reimbursement for the Q3014 code is $79.45.2 - The patient must be present and participative in the telemedicine visit, the system for which must include interactive audio and video delivered in real time at the originating and distant sites.
- Additional reimbursement is only available to providers who typically bill on a CMS-1500 claim form.
Screening for Hepatitis C
National data indicates that New Mexico has the highest prevalence of Hepatitis C virus (HCV) infection of any state (one source estimates the infection rate at 1.3% of the non-incarcerated population). With an asymptomatic phase that may last decades, it is important for those at increased risk to be offered screening so that exacerbating behaviors can be modified and potentially curative treatment can be considered. View full story Annual HEDIS Medical Record Data Collection for 2016
As previously communicated in the January 2016 and February 2016 issues of Blue Review, Blue Cross and Blue Shield of New Mexico (BCBSNM) is collecting data to meet the requirements of the National Committee for Quality Assurance (NCQA) for Healthcare Effectiveness Data and Information Set (HEDIS®) and by the U.S. Department of Health and Human Services (HHS) for the Quality Rating System (QRS). You may receive a request for medical records for one or more of your patients as a part of this process. The request will specify the timeframe and data elements required. It is important that the data collection instructions are followed for each measure.
View full story Survey shows: Medicaid members give their providers high ratings
Each spring we survey our members to find out how happy they are with us and with you, our providers. Using the Consumer Assessment of Healthcare Providers and Systems (CAHPS®), we give members the opportunity to rate the services we offer and the health care you provide. In 2015, members gave us both high marks. View full story Looking back at HEDIS®: Results for HEDIS 2013, 2014 and 2015
With requests for medical records arriving by fax and phone for HEDIS 2016, we thought a look back at previous HEDIS seasons would show the progress we have made – and continue to make – to provide effective health care to our Medicaid members. View full story Our Medicaid Quality Improvement Program
The principle goal of the Medicaid Quality Improvement (QI) Program is to improve our members’ health. We strive to help them understand the importance of taking better care of themselves and their families. Every year we develop a quality improvement plan in which we set specific quality goals, identifying the activities we will implement to achieve them and defining how we will measure our progress. All activities and goals lead back to the primary goal; improved health for our members, your patients. 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 | 