Blue Review, Issue 4, 2009
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From the director’s chair: Collecting fees at time of service
It has come to the attention of Network Management that hospitals in the BCBSNM network have been requesting full payment from members for a medical service prior to the procedure. While facility and professional contracts do allow for collection of copayments (check the member’s card for the correct copayment amount), coinsurance, and deductibles from members, the charge must be based on the negotiated fee schedule.
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Medical Policy updates
Approved new or revised Medical Policies may impact your reimbursement and your patients’ benefits.
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Talking with Health Services staff
Health Services staff members are available to talk to you about important care management issues Monday through Friday.
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Drug List updates
The BCBSNM and Prime Therapeutics® Pharmacy and Therapeutics Committee met on February 23, 2009, and recommended the following changes to the BCBSNM Drug List.
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Medicare Part D formulary updates
Formulary updates for the first quarter of 2009.
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Referrals for behavioral health and chemical dependency services
BCBSNM contracts with Mesa Mental Health for behavioral health care, detoxification, and chemical dependency rehabilitative services for most members.
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Take advantage of our online resources
Learn how the BlueCard® Program Provider Manual, the Blues Provider Reference Manual, and our revised electronic commerce enrollment forms can help you work more efficiently with your BCBSNM patients.
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Status report: ID card conversion to new format
BCBSNM is in the process of converting member ID cards to a new format to meet the Blue Cross and Blue Shield Association requirement that all Blues Plans adopt a standardized card format. At the same time, we are converting to new technology to produce the cards and introduce a magnetic stripe.
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We’re making the transition to e-commerce easier for you!
We are listening to our contracted providers’ concerns and have made changes to our electronic commerce offerings.
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Byram Healthcare provides complimentary Latino care program
Byram Healthcare, a national leading provider of home medical supplies, has developed culturally relevant programs for the U.S. Latino population.
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Office Staff
New National Provider Identifier (NPI) edit information
To avoid claim payment delays, you must include the corresponding TIN or SSN along with your NPI.
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Electronic remittance advice (835) update
In preparation for BCBSNM’s 835 files to be transitioned to Availity, a unique identifier was added on February 20, 2009.
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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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Are you receiving multiple paper checks for Medicare crossover claims?
Receiving a check for every Medicare crossover claim that is processed, along with following up on processing errors and payment delays, can inconvenience you and your office staff.
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The most commonly used forms on bcbsnm.com and their uses
Network Management contacts and related service areas
Network Management professional contracting service areas map
Blue Medicare PPOSM
Pre-authorization requirements
Several services require pre-authorization for participating Blue Medicare PPO providers.
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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
Premium Assistance for Kids (PAK)
BCBSNM is pleased to announce that we are now one of the three managed care organizations administering the PAK program, which is designed to provide health care coverage for children who are uninsured, but not eligible for Medicaid coverage due to income.
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Pharmacy pre-authorizations for BlueSalud members
BCBSNM uses online edits at the pharmacy point-of-sale and pre-authorization process to ensure that BlueSalud members receive medications and dosages that are safe and efficacious.
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Required preventive health screenings for BlueSalud members, part two
To promote the health and wellness of our members and communities, BCBSNM would like to remind participating BlueSalud providers of the Medicaid Managed Care Standards for Preventive Health Services.
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BlueSalud membership steadily growing
As of March 2009, there were 5,725 members enrolled in our BlueSalud Medicaid program.
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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 4, 2009
