February 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
Receipt of Credentialing Application Notification BCBNM will notify applicants by certified mail within 10 days of receipt that the credentialing request has been received and that: - If the application is found to be complete, the credentialing process will begin according to the 45-day time period set forth in Subsection C of 13.10.28.11 NMAC.
- If the application is found to be incomplete, the 45-day credentialing process DOES NOT commence until all requested information has been provided and application deemed complete by BCBSNM.
80% by 2018 Will you commit?
In cooperation with the American Cancer Society and the National Colorectal Cancer Roundtable, Blue Cross and Blue Shield of New Mexico (BCBSNM) pledged to have 80% of BCBSNM’s members age 50-75 screened for colon cancer by 2018. Read more
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.
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.
Preterm Labor Prevention Program
Blue Cross Community Centennial has the Special Beginnings® Maternity Care Coordination Program. This program is designed to help pregnant members better understand and manage their pregnancy. There is a program within this program known as the Preterm Labor Prevention Program. Women with a history of preterm labor and/or delivery may be candidates for 17 Alpha-hydroxyprogesterone caproate, or 17-P. Providers who identify their patients requiring this additional support can work collaboratively with BCBSNM and the Special Beginnings Care Coordinators to implement this program. For members not previously identified at risk for preterm labor/delivery the following steps are in place. Read more 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
Additional Code-auditing Software Scheduled for Implementation as of April 30, 2017
Blue Cross and Blue Shield of New Mexico (BCBSNM) will be implementing an additional code-auditing software system, effective April 30, 2017. * This software will enhance auditing of professional and outpatient facility claims for correct coding according to Healthcare Common Procedure Coding System (HCPCS), Current Procedural Terminology (CPT®) and Centers for Medicare & Medicaid Services (CMS) guidelines. Upon implementation, providers may use the Claim Inquiry Resolution tool, available on the AvailityTM Web portal, to research specific claim edits. For additional information, watch the Blue Review, as well as the News and Updates section of our Provider website. Read more
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 | 