April 2018
In this month’s Blue Review: CERA, Shingrix, NDC Calculator and more... Please share this newsletter with others in your group or practice.
Blue Review is Getting an Update!
Beginning in May, Blue Review will have a new, easier-to-read format designed to get you the information you need quickly. Along with the new look, the Blue Review publication schedule will change to the second Friday of each month. If you have any questions, please feel free to email NMBlueReviewEditor@bcbsnm.com.
Updated Forms are Available on Provider Website
Staying up to date is important for all aspects of health care, including using the most current forms available on the Blue Cross and Blue Shield of New Mexico (BCBSNM) provider website at bcbsnm.com/provider. When sending forms via facsimile, make sure to verify the fax number on the form and that all requested information is complete and accurate. You can find the current versions of forms for everything from behavioral health to pharmacy, and more, under the Education and Reference tab of the provider website. For more information, or if you have any questions about submitting forms to BCBSNM, please contact your Provider Network Representative at 1-800-567-8540 or 505-837-8800. Quickly Manage and Respond to Risk Gaps through the Availity Web Portal
The CERA application allows providers to electronically respond to requests for information related to potential risk adjustment gaps for BCBSNM members. Read more BCBSNM Approves Coverage of New Shingles Vaccine: Shingrix
The new Shingrix vaccine is not only 91% effective, but is now also covered by BCBSNM! Read more Cancer Prevention: The Added Value in Adolescent Immunizations
The CDC estimates that 79 million people are currently infected with HPV in the US, and 14 million more will become infected each year. Vaccination can prevent infection by ‘higher risk’ types of HPV that are associated with various types of cancers. Read more Working Together to Improve the Member-Provider Experience: Choosing the Best Direction
This is the first in a series where we address some of our members’ most frequent concerns. This month we focus on referrals to other providers and facilities. Read more Updated Online NDC Units Calculator Tool Now Available
RC Claim Assist is a new NDC units calculator tool available through Availity. Read more Fall Prevention: Resources for Providers and Members
As Americans are living longer than ever, the likelihood and dangers posed by falls increase. Find out what you can do to help your patients, our members, prevent falls. Read more Blue Cross Community CentennialSM (Medicaid) Rendering, Ordering, Attending and Referring Provider Information Required for Blue Cross Community Centennial Claims
As a reminder, in accordance with the requirements found in the New Mexico Human Services Department (HSD) Supplements17-07 ,17-08 and 17-09, released on Sept. 11, 2017, the appropriate rendering, ordering, attending and referring provider must be billed on claim submissions. Effective for claims with dates of service Apr. 15, 2018, and after, providers must include the appropriate information regarding the rendering, ordering, attending and referring providers on all claim submissions. If this detailed information is not included in the claim submission, Blue Cross and Blue Shield of New Mexico will deny Blue Cross Community Centennial claims for dates of service on or after Apr. 15, 2018. Please refer to the HSD Supplements for the situations which are exempt from this requirement.
For more information about including the appropriate rendering, ordering, attending and/or referring provider information on Blue Cross Community Centennial Claims, please refer to the HSD Supplements above or contact your provider network representative at (505) 837-8800 or toll free at 1-800-567-8540. CareLink New Mexico Integrates Physical and Behavioral Health Services
CareLink New Mexico (CLNM) is a program to coordinate the integration of physical and behavioral health services for Medicaid beneficiaries with diagnoses of Serious Mental Illness (SMI) or Severe Emotional Disturbance (SED). The following organizations and facilities are available to create network relationships, which may be established through memoranda of agreement (MOAs) (required for primary care, local hospitals and residential treatment facilities) or other less formal processes.
Visit the Medicaid page at bcbsnm.com/provider for more details. 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. | 