January 2017 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.
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 Quarterly Updates
New and revised Current Procedural Terminology (CPT®) and Healthcare Common Procedure Coding System (HCPCS) codes are periodically added to or deleted from the ClaimsXten code auditing tool software by the software vendor on a quarterly basis and are not considered changes to the software version. Read more Annual Medical Record Data Collection for Quality Reporting begins February 1, 2017
Blue Cross and Blue Shield of New Mexico (BCBSNM) collects performance data using specifications published by 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). HEDIS is the most widely used and nationally accepted effectiveness of care measurement available and HHS requires reporting of QRS measures. These activities are considered health care operations under the Health Information Portability and Accountability Act (HIPAA) Privacy Rule and patient authorization for release of information is not required. Read more
Opiates
It has been shown that people who use opiates at daily doses greater than 100 to 120 morphine equivalents have a substantially higher risk of accidental overdose when compared with patients receiving less than a 100 to 120 morphine equivalents per day.1-5 Therefore, as of January 1, 2017, BCBSNM Centennial Care members will be subject to a Morphine Equivalent Dose (MED) quantity limit of 120 mg per day over a rolling 90-day period. Patients who require quantities of opiates at doses exceeding 120 MED per day, over a 90-day period, will need to obtain prior authorization. Read more LARC use in Adolescents 15-19
Forty-two percent of adolescents aged 15-19 in the United States have had sexual intercourse1. Adolescents most commonly use contraceptive methods with a higher risk of failure, such as condoms, withdrawal, or oral contraceptive pills. Furthermore, 82% of adolescent pregnancies are unplanned, which may indicate that this population may not have access to reliable and effective contraceptive methods. Read more BCBSNM Vision Plan Transitions to EyeMed - Revisions
Effective Jan. 1, 2017, Blue Cross and Blue Shield of New Mexico (BCBSNM) members will transition from Davis Vision to EyeMed Vision Care. This impacts BCBSNM members with the voluntary plan (premier or preferred), pediatric members (in individual, small group and student health markets) and Blue Cross Medicare AdvantageSM members. In November, we sent letters to affected members notifying them of the new vision vendor. With EyeMed Vision Care, the member also receives discounts on eyewear materials in addition to the funded benefit. Should you have any questions regarding this transition, please contact your BCBSNM Provider Network Representative for assistance. For all other BCBSNM members, providers for vision care could vary. Contact the customer service number on the back of the member’s ID card to verify the member’s vision benefits. Medicaid only
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. Such services are funded in part with the State of New Mexico.
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