Blue Review, Issue 6, 2009
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Blue Review Survey
From the director’s chair: Frequently asked questions about BCBSNM and the 2009 Resource-Based Relative Value Scale (RBRVS)
In the May issue of Blue Review, I indicated that we would inform you of BCBSNM’s position on converting to the 2009 CMS RVUs. By now you should have received a letter about this change. The following FAQs should assist you in understanding BCBSNM’s position.
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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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How to reach the correct authorization unit when calling Health Services
When you call the BCBSNM Health Services line for authorizations, it is important to listen carefully to all the options to reach your party efficiently.
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Be Smart. Be Well.TM features new topic on childhood obesity
Childhood obesity, the latest topic to be covered on Be Smart. Be Well., addresses the causes and dangers associated with this serious health epidemic as well as what families can do to prevent it.
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In the know: Keep your Provider Request for Claim Review Form neat and complete
While it is important to include all required information on the Provider Request for Claim Review Form, such as claim and provider data, the reason for the review and any necessary documentation, it is equally important to ensure that all information included on the form is accurate and legible.
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Providers enjoy increased security and efficiency of paperless transactions
The providers we surveyed earlier this year told us that electronic transactions have helped them save time by standardizing office processes. Providers also commented on the efficiency, convenience, and environmental friendliness of electronic transactions.
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Free blood glucose meter offer
BCBSNM members who are newly diagnosed with diabetes can receive a free blood glucose meter from either Roche Diagnostics or Abbott Diabetes Care.
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Office Staff
Do you have separate billing NPIs for other payers? Let us know!
On your BCBSNM claims, please use the billing NPI that replaced your former BCBSNM provider number, where applicable. In the event of any changes, such as deactivation of an existing NPI, it is important that you notify BCBSNM so that we may keep your provider record up-to-date.
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BlueCard® quick tip: How to identify a BlueCard member
This month’s tip will help you identify out-of-area Blue Plan members who may seek your services via our BlueCard Program.
View full story 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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Providers who have joined and left the BCBSNM network, April 2009
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Network Management contacts and related service areas
Network Management professional contracting service areas map
Blue Medicare PPOSM
Therapy cap information for 2009
The Balanced Budget Act of 1997 established limits on outpatient therapy services. These limits change annually.
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Summary of the 2010 Centers for Medicare & Medicaid Services Call Letter
On March 30, 2009, the CMS issued its final 2010 Call Letter, which provides guidance to Medicare Advantage organizations (MAOs) and Part D plan sponsors on new regulatory requirements and statutory changes.
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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
Initial decisions, appeals, and grievances
The “initial decision” is the first decision BCBSNM makes about coverage or payment for care. In some instances, a participating provider acting on behalf of a member may make a request for an initial inquiry on whether a service will be covered.
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The BlueSalud referral process
This article includes general guidelines as well as guidelines for in- and out-of-network specialists, OB/GYN services, and family planning services.
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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.
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Cultural competency and diversity
Health care providers who participate in BlueSalud must understand cultural competency as it pertains to their practices.
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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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BCBSNM makes no endorsements, representations, or warranties about any products or services offered by independent third-party vendors mentioned in this newsletter. The vendors are solely responsible for the products or services offered by them. If you have any questions about the products or services mentioned in this newsletter, contact the vendor directly.
Blue Review, Issue 6, 2009
