Blue Review, issue 5, 2009
Ancillary providers may enroll in e-commerce transactions
BCBSNM offers electronic commerce (e-commerce) tools to all of its independently contracted providers, including many types of ancillary providers.
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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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New Mexico Adult Diabetes Practice Guideline now available
This guideline, provided by New Mexico Health Care Takes On Diabetes, is based on the recommendations of the American Diabetes Association and summarizes core elements appropriate to most adults with diabetes.
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New Mexico works to implement e-prescribing
In an effort to motivate provider adoption, New Mexico health payers and the New Mexico Medical Review Association launched the New Mexico Prescription Improvement Coalition (NMPIC) e-prescribing pilot in late 2008. The effort to demonstrate the effectiveness of e-prescribing locally will sponsor up to 100 physicians to adopt e-prescribing.
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Noncovered services
BCBSNM does not cover services for which the member has no legal obligation to pay or that are free.
View full story Using your National Provider Identifier (NPI) on electronic inquiries about BCBSNM members
BCBSNM physicians and medical providers using the Availity® portal may, in certain situations, have received out-of-network instead of in-network benefit information. This may have occurred when providers submitted the transaction for the member’s eligibility and benefits (E&B) status using the billing provider NPI rather than the rendering provider NPI.
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Provider alert: BCBSNM fee schedules and RBRVS
Be on the lookout for a letter from BCBSNM.
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Protect yourself against health insurance fraud: Watch our provider awareness demo
Reducing health care fraud requires a joint effort between you – our contracted providers – and our Special Investigations Department (SID). SID provides information and training to its members and providers to educate them about the health and financial risks associated with health care fraud.
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UNM Cancer Center receives Blue Distinction® recognition
The Blue Cross and Blue Shield Association (BCBSA) has recognized the UNM Cancer Center for its achievement of high standards of care and best practices in cancer care, as defined by a collaboration of physicians and hospitals to improve quality outcomes and affordability.
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Our privacy practices protect your BCBSNM patients
Our Notice of Privacy Practices (NoPP) explains how we protect the privacy of our members. Your BCBSNM patients can obtain a copy of the NoPP in one of the three ways.
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Member rights and responsibilities
Our health plan members have rights and responsibilities that are listed in their Benefit Booklet or Member Handbook.
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Office Staff
BlueCard® tip: When and how to send medical records
It is important to send medical records only when they are requested. Do not send medical records with your claims, as unsolicited claim attachments may cause payment delays. Submit your claims electronically and BCBSNM will notify you if medical records are needed.
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Behavioral health authorization alert
Effective May 1, 2009, BCBSNM will no longer allow retroactive behavioral health authorization requests.
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Christus St. Vincent adds operating rooms
The Christus St. Vincent Regional Medical Center Surgical Services Department has completed the first phase of a two-phase expansion and renovation project. This completion offers a new surgical services wing to provide comprehensive services to the northern and central New Mexico population.
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Need claim filing information? We have it online
We’re continuously updating our website to bring you accurate information on filing claims.
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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.
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Network Management contacts and related service areas
Network Management professional contracting service areas map
New! Providers who have joined and left the BCBSNM network, March 2009
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Blue Medicare PPOSM
Blue Medicare PPO medical coverage policies
As a Medicare Advantage plan, Blue Medicare PPO must cover all services and benefits covered by Medicare. Coverage information you receive concerning original Medicare also applies to Blue Medicare PPO.
View full story Correct billing address for Blue Medicare PPO claims
Blue Medicare PPO claims should not be submitted to BCBSNM in Albuquerque. Please submit Blue Medicare PPO claims according to our guidelines.
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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
To promote the health and wellness of our members and communities, BCBSNM would like to remind providers of the Medicaid Managed Care Standards for Preventive Health Services (New Mexico Administrative Code 8.305.8.16).
View full story BlueSalud reimbursement alert! New Site of Service Differential Fee Schedule
On April 1, 2009, BCBSNM implemented a Site of Service Differential Fee Schedule. This differential applies to professional services rendered within a facility setting.
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Financial responsibilities for BlueSalud members
Providers who participate in Medicaid agree to accept the amount paid as payment in full, with the exception of copayment amounts required in certain Medicaid categories.
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Case management for BlueSalud patients
BCBSNM nurses provide individual case management for our members with chronic, complex, or catastrophic conditions. Case management activities are based on national standards of practice from the Case Management Society of America.
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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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Blue Review, Issue 5, 2009
