March 2018
In this month’s Blue Review: Interpreting ERAs, Pharmacy Changes, Behavioral Health, and more... Please share this newsletter with others in your group or practice.
Interpreting the “PLB” Segment on the 835 ERA
There are reversals and corrections when claim adjudication results have been modified from a previous report. Adjustments in the PLB segment can either decrease the payment or increase the payment. Read more Making the Health Care System Work Better Together
We’re working with business and thought leaders, inside and outside of our organization, to explore ways we can all work together to make the health care system work better for everyone. Read more Quarterly Pharmacy Changes Effective Jan. 1, 2018
Based on availability of new prescription medications and review of the pharmaceuticals market, revisions and/or exclusions were made to the BCBSNM drug lists. Read more March into Colon Cancer Awareness Month
Did you know that in the United States, colorectal cancer (CRC) is the second largest cause of cancer deaths for men and women? This highly preventable disease kills more than 50,000 people per year. The Centers for Disease Control and Prevention (CDC) and U.S. Preventive Services Task Force (USPSTF) have published guidelines and information for both patients and providers regarding CRC screening. Both the CDC and the USPSTF recommend colorectal cancer screening starting at age 50. The best CRC screening test is the one that gets done! Follow the links above for more information about CRC and screening options. Behavioral Health: Let’s Talk About It!
The first step to bridging the gap may be simply talking about behavioral health more. People with behavioral health issues should not feel embarrassed to come forward, particularly when it comes to reaching out to friends, family and health care providers who can help. Read more Blue Cross Community CentennialSM (Medicaid) New Medicaid ID Numbers for Members
Starting in December 2017, HSD began issuing newly enrolled Medicaid members Medicaid ID numbers beginning with “00002”. Read more Not yet contracted?
Providers who are participating in commercial BCBSNM products are not automatically participating providers in Blue Cross Community Centennial. If you are interested in becoming a Blue Cross Community Centennial provider, please call 505-837-8800 or 1-800-567-8540. 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. Such services are funded in part with the State of New Mexico. Provider Resources
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 via our website, bcbsnm.com/provider, and our provider newsletter, Blue Review. Read more Signing up is easy. Go to bcbsnm.com/provider, select Update Your Information, complete the form, and click Submit. We guard your privacy. BCBSNM treats your email address as confidential. We never sell or give your email address(es) to any third party without your permission. Don’t have email? If you do not have an email address, please call 1-800-567-8540 or (505) 837-8800. We can mail paper copies of Blue Review to providers. The Blue Review is posted online after the email distribution date—go to bcbsnm.com/provider, then select Blue Review. Stay current with BCBSNM provider Education and Reference news and updates regularly. 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. These policies are located under the Standards & Requirements tab at bcbsnm.com/provider.
Claims inquiries?
Our Provider Service Unit (PSU) handles all provider inquiries about claims status, eligibility, benefits, and claims processing for BCBSNM members. Call 888-349-3706 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 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. Please complete our quick and easy online form for any changes to contact or practice information. Member Rights and Responsibilities
BCBSNM policies help address the issues of members participating in decision making regarding their treatment; confidentiality of information; treatment of members with dignity, courtesy and a respect for privacy; and members’ responsibilities in the practitioner-patient relationship and the health care delivery process. Read more You can find Blue Review online!
We want your feedback on Blue Review! Have suggestions for future articles? Drop us a line anytime: NM_Blue_Review_Editor@bcbsnm.com. | 