Our annual HEDIS® visits and privacy regulations
During the next few months, BCBSNM nurses will be visiting physician offices to gather information for the nationally validated Healthcare Effectiveness Data and Information Set (HEDIS).
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Medical Policy updates
Approved new or revised Medical Policies and their effective dates are posted on our website the first day of each month. These policies may impact your reimbursement and your patients’ benefits.
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E-prescribing now available at PrimeMail®
E-prescribing allows you to electronically transmit your patient’s prescription to the pharmacy of his or her choice. When the patient runs out of refills, the pharmacy can electronically transmit a refill request to your office for approval.
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From the director’s chair
The 2008 provider satisfaction survey results indicated that BCBSNM could improve its provider communication channels. We are approaching this challenge on three fronts: improving our newsletter format and delivery, redesigning our website for ease of use, and making improvements to the Interactive Voice Response system (IVR).
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Our utilization management determinations
BCBSNM personnel makes utilization management determinations based only on appropriateness of care, cost-effectiveness, benefit provisions, and existence of coverage.
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Caregiving: It’s all of us
Caregiving is the latest topic on Be Smart. Be Well., a website developed by Blue Cross and Blue Shield to offer consumers in-depth information on largely preventable health and safety issues.
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We are here to help you
In each issue of Blue Review, we profile employees of Provider Network Management, the Provider Service Unit (PSU), the Provider Access and Servicing Strategy (PASS) unit, or Health Care Management (HCM), describing what they do for you, the provider. This issue features Daniel Garcia, a PASS team member.
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2008 reader survey results
Overall, the readers’ responses were very positive. Most of the participants scanned all six issues in 2008, and read at least some of each issue. Approximately 75 percent of the participants said Blue Review was “very good” in terms of ease of reading and organization of information.
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Office Staff
Clear Claim Connection™ can increase your claims efficiency
Clear Claim Connection* (C3) is a Web-based code auditing reference tool that allows BCBSNM to disclose our payment policies, rules, and edit rationale to our providers. C3 increases coding and payment transparency and helps providers understand complex payment policies.
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In the know: What can e-commerce do for your office?
E-commerce tools such as electronic claims filing, electronic funds transfer (EFT), electronic remittance advice (ERA), and electronic payment summary (EPS) can make your job easier in many ways.
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In the know: How to get a BCBSNM fee schedule
Obtaining a fee schedule is easy: simply download the Fee Schedule Request Form.
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BlueCard® quick tips
Did you know that the BlueCard Program allows you to submit claims for members from other Blue Cross and Blue Shield Plans, domestic and international, directly to the New Mexico Plan?
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Wellness resources for your patients
We’ve recently made posters and pads with information about weight management and smoking cessation available to our providers. Designed for display in your office, the posters offer quick, memorable tips, and the pads include take-away pointers. Both items are available in English and Spanish.
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Two new facilities in our provider network
Lovelace Rehabilitation Hospital and ABQ Health Partners have opened new facilities.
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Claims inquiries? Call the Provider Service Unit (PSU) at 888-349-3706
Our PSU handles all provider inquiries on claims status, eligibility, benefits, and claims processing issues for BCBSNM members.
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Network Management contacts and related service areas
Network Management professional contracting service areas map
Blue Medicare PPOSM
Informing Blue Medicare PPO members about advance directives
Advance directives are recognized under New Mexico law and are signed by a patient. Blue Medicare PPO members have the right to complete advance directive statements.
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Blue Medicare PPO provider network addition
Effective January 2009, Lab Corp of America is a participating Blue Medicare PPO provider with offices in Albuquerque, El Paso, and Los Alamos.
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Not yet contracted for Blue Medicare PPO?
Providers who are participating in commercial BCBSNM products are not automatically considered participating providers in Blue Medicare PPO.
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BlueSaludSM
Required preventive health screenings for BlueSalud members
Some preventive health screenings are required by Medicaid for BlueSalud members.
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BlueSalud member rights and responsibilities
BlueSalud members have the right to timely, high-quality care, and treatment with dignity and respect.
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Not yet contracted for BlueSalud?
Providers who are participating in commercial BCBSNM products are not automatically considered participating providers in BlueSalud.
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