September 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!

Your Feedback Is Important
Blue Review strives to offer important information each month to our contracted providers. To deliver the content that’s most relevant to you and all staff, BCBSNM needs your feedback. Please take a few minutes to complete our brief survey. As a thank you for your time, we’re providing an opportunity to win one of five, $25 Amazon.com^® gift certificates. (Note: government employees are not eligible.)
Take the survey.

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

BCBSNM Website
It’s important for you to stay informed about news that could affect your practice. Blue Cross and Blue Shield of New Mexico (BCBSNM) offers many ways to stay informed. When you visit our website, bcbsnm.com/provider, and sign up to receive email updates and our provider newsletter, Blue Review, you get better access to timely information on topics. Read more

Member Rights and Responsibilities

BCBSNM members have the right to:

• Available and accessible services when medically necessary, as determined by the primary care or treating physician in consultation with BCBSNM, 24 hours per day, 7 days a week, or urgent or emergency care services, and for other health services as defined by the member’s benefit booklet.
• Be treated with courtesy and consideration, and with respect for their dignity and need for privacy.
• Have their privacy respected, including the privacy of medical and financial records maintained by BCBSNM and its health care providers as required by law.
• Be provided with information concerning BCBSNM’s policies and procedures regarding products, services, providers, appeals procedures and other information about the company and the benefits provided.
• All the rights afforded by law, rule, or regulation as a patient in a licensed health care facility, including the right to refuse medication and treatment after possible consequences of this decision have been explained in language they understand.
• Receive from their physicians or providers, in terms that they understand, an explanation of their complete medical condition, recommended treatment, risks of the treatment, expected results and reasonable medical alternatives, irrespective of BCBSNM’s position on treatment options. If they are not capable of understanding the information, the explanation shall be provided to their next of kin, guardian, agent or surrogate, if able, and documented in their medical record.
• Prompt notification of termination or changes in benefits, services or provider network.
• File a complaint or appeal with BCBSNM or with the New Mexico Superintendent of Insurance and to receive an answer to those complaints within a reasonable time.
• Request information about any financial arrangements or provisions between BCBSNM and its network providers that may restrict referral or treatment options or limit the services offered to members.
• Adequate access to qualified health professionals near their work or home within New Mexico.
• Affordable health care, with limits on out-of-pocket expenses, including the right to seek care from an out-of-network provider, and an explanation of their financial responsibility when services are provided by an out-of-network provider, or provided without required preauthorization.
• Detailed information about coverage, maximum benefits, and exclusions of specific conditions, ailments or disorders, including restricted prescription benefits, and all requirements that they must follow for preauthorization and utilization review.
• Make recommendations regarding BCBSNM’s member rights and responsibilities policies.
• A complete explanation of why care is denied, an opportunity to appeal the decision to BCBSNM’s internal review, the right to a secondary appeal, and the right to request the assistance of the Superintendent of Insurance. BCBSNM members have the responsibilities to:
• Supply information (to the extent possible) that BCBSNM and its network practitioners and health care providers need in order to provide care.
• Follow plans and instructions for care that have been agreed on with their treating provider or practitioners.
• Understand their health problems and participate in developing mutually agreed upon treatment goals with their treating provider or practitioner to the degree possible.

Adult BMI Assessment
Screening for health risk factors in adults ages 20 to 74 can begin with a brief discussion of the patient’s current Body Mass Index (BMI). In young adult patients ages 18 to 20, a discussion of BMI percentile is warranted. The BMI, an indicator of body fat, can create an opportunity to assess and discuss activity, diet, alcohol, use of pain medications, smoking patterns and other lifestyle choices that may impact health.  Read more

Identifying and Prescribing Correct Glucose Meter Test Strips
When prescribing glucose meter test strips, it is important to verify the type of glucose meter the patient is using and which test strips it requires. Some glucose meters have similar names, but require different types of test strips. Read more

Medicaid only

Blue Cross Community Centennial^SM (Medicaid)

Not yet contracted?
Blue Cross and Blue Shield of New Mexico’s (BCBSNM) 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.

Member Rights and Responsibilities
Blue Cross and Blue Shield of New Mexico (BCBSNM) is committed to ensuring that enrolled members are treated in a manner that respects their rights as individuals entitled to receive health care services.
Read more

HSD No Longer Issuing Separate Medicaid Cards for MCO-Enrolled Members
Effective Jan 1, 2018, the New Mexico Human Services Department, Medical Assistance Division (HSD/MAD) will no longer issue Medicaid identification cards to Medicaid recipients who are enrolled with a Managed Care Organization (MCO).  

Please note that as of Jan. 1, 2018, Medicaid recipients who enroll with Blue Cross Community Centennial^SM will only receive a Blue Cross and Blue Shield of New Mexico-issued member ID card, which shall include the member’s name, group number, and MCI ID number. Letters accompanying ID cards will explain that members will not receive a separate Medicaid card from HSD.

Providers should continue to ask for the ID card from Blue Cross and Blue Shield of New Mexico, but should no longer ask Blue Cross Community Centennial members to present an ID card from HSD. Be sure to verify eligibility before furnishing covered services.

If you have any questions regarding this change, please contact your regional network provider representative at 1-800-567-8540.

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

Screening for Clinical Depression Initiative
Blue Cross and Blue Shield of New Mexico (BCBSNM) is committed to promoting annual screening and follow-up treatment for depression in the primary care setting for Blue Cross Community Centennial members. Read more

Blue Cross Medicare Advantage^SM

Member Rights and Responsibilities
Blue Cross Medicare Advantage members have the right to timely, high quality care and treatment with dignity and respect. Participating providers must respect the rights of all members. Blue Cross Medicare Advantage members have been informed that they have the following rights and responsibilities. Read more

Blue Cross Medicare Advantage: Electronic Claim Submission Edits
Beginning Sept. 16, 2017, Blue Cross and Blue Shield of New Mexico (BCBSNM) will implement new electronic claim submission validation edits for Blue Cross Medicare Advantage (PPO)^SM and Blue Cross Medicare Advantage (HMO)^SM Professional and Institutional claims (837P and 837I transactions). Read more

Government Programs: Claims Rejecting as Duplicate Submissions
This notice applies to claims submitted by government programs providers for the following Blue Cross and Blue Shield of New Mexico (BCBSNM) members: Blue Cross Medicare Advantage (PPO)^SM (MA PPO) and Blue Cross Medicare Advantage (HMO)^SM (MA HMO) Read more

Prohibition on Billing Dually-Eligible Members Enrolled in the Qualified Medicare Beneficiary Program
Medicare providers may not bill, charge, collect a deposit, or seek reimbursement from any Medicare and Medicaid dually-eligible members enrolled in the Qualified Medicare Beneficiary (QMB) program. Read more

Federal Employee Program^®

Federal Employee Program Member Rights and Responsibilities
BCBSNM Federal Employee Program members have the right to Read more