Blue Review | Blue Cross and Blue Shield of New Mexico

2021

December 2021 — Read these articles and more...

COVID-19 Information for Providers
Catch Up on Vaccines for All Ages
Information About the 2021 2022 Flu Season and Vaccination
Single Sign On Access to AIM Specialty Health^® via Availity^®
New Provider Designations and Services Forms for Provider Onboarding Applications
Watch for a Letter on Fighting Fraud, Waste and Abuse
Current Procedural Terminology (CPT^®) Codes Updated for Prior Authorization (Commercial/Retail and Medicaid)
Current Procedural Terminology (CPT^®) Codes Updated for Prior Authorization (Medicare)
Claim Editing Enhancements Coming Jan. 10, 2022
Including Behavioral Health Diagnoses on Claims and Referring to Behavioral Health Providers
View Withdrawn Claim Descriptions via the Availity Claim Status Tool
Reminder: Medicaid Providers Can Receive Payment for Project ECHO Consultations
Health Benefits of Collaborating with Eye Care Professionals
Hospital Discharge Summaries Are Important to Empower Members and Inform Specialists and Primary Care Providers
Reminder to Encourage Early and Timely Intervention for Pre- and Post-Partum Care Even Now
Our Medicaid Quality Improvement Program
CMS Required Training for Dual Special Needs Plans
Required Cultural Competency Training Available Online

November 2021 — Read these articles and more...

COVID-19 Information for Providers
New Laboratory Policies Coming Jan. 1, 2022
2022 Telemedicine Services
Pharmacy Program Updates: Quarterly Pharmacy Changes Effective Oct.1, 2021 — Part 2
Delivering Quality Care: Avoiding Antibiotics for Acute Bronchitis
Delivering Quality Care: Managing Diabetes
BCBSNM Moves to Streamline Coordination of Benefits for Members with Secondary Coverage
Introducing Electronic Clinical Claim Appeal Requests via Availity^® Provider Portal
Initiation of Substance Use Disorder Provider Enhanced Payment Program — Blue Cross Community Centennial
Provider Incentive Program for Weight Assessment and Counseling for Children and Adolescents — Blue Cross Community Centennial
Surprise Billing Provisions of No Surprises Act
Provider Directory Information Verification
Continuity of Care Changes
New Information on Member ID Cards
Machine-Readable Files
CMS Required Training for Dual Special Needs Plans
Required Cultural Competency Training Available Online

October 2021 — Read these articles and more...

COVID-19 Information for Providers
Coverage Replacement for Smoking Cessation Product CHANTIX^® Due to Voluntary Recall
Reminder: Use AIM for Prior Authorization — Coming for Pharmacy Medical Oncology
Change to Some Primary and Secondary Claims Coordination
Documentation and Coding: Coding Cancer and Cancer-Related Treatments
Delivering Quality Care: Breast Cancer Screening
Are You Using These Shared Decision-Making Aids?
Reminder: Controlling High Blood Pressure
ClaimsXten^TM Quarterly Update Reminder
Earn CME/CEU Credit at Free Webinar on Comorbid Conditions
CMS-Required Training for Dual-Special Needs Plans
Enhanced Clinical Editing Processes Begin Jan. 1, 2022 for Blue Cross Community Centennial Claims
In-Home Diabetes Monitoring Tests Coming to Select Blue Cross Community Centennial Members
Required Cultural Competency Training Available Online

September 2021 — Read these articles and more...

COVID-19 Information for Providers
Current Procedural Terminology (CPT^®) Codes Updated for Prior Authorization
Documentation and Coding: Obesity and Morbid Obesity
Updates to Clinical Practice and Preventive Care Guidelines
Pharmacy Program Updates: Quarterly Pharmacy Changes Effective Oct. 1, 2021 — Part 1
Current Procedural Terminology (CPT^®) Codes Updated for Prior Authorization for Medicare Programs
Availity^® Claim Status Response Enhancement for Medicare Advantage Claims
CMS-Required Training for Dual-Special Needs Plans
Required Cultural Competency Training Available Online
Reminder: Update your Enrollment Information

August 2021 — Read these articles and more...

COVID-19 Information for Providers
Prior Authorization Update – Pharmacy Medical Oncology
Behavioral Health Provider Access Standards
Adhering to HPV and Shingles Vaccine Guidelines
Delivering Quality Care: Antidepressant Medication Management
Colorectal Cancer Screening for Members Age 45 to 75
National Drug Code (NDC) Fee Schedule Changes Effective Sept. 1, 2021
CMS-Required Training for Dual-Special Needs Plans
Required Cultural Competency Training Available Online
Reminder: Update your Enrollment Information

July 2021 — Read these articles and more...

COVID-19 Information for Providers
Coming Soon: View Professional Provider Fee Schedule via Availity^®
Reminder: Current Procedural Terminology (CPT^®) Codes Updated for Prior Authorization
Delivering Quality Care: Supporting Mental Health
Catch Up Now on Child and Adolescent Vaccinations
Earn CME/CEU Credit at Free Webinar on Opioid Use
In Home Test Kits for Colorectal Cancer Screening
Pharmacy Program Updates: Quarterly Pharmacy Changes Effective July 1, 2021 — Part 2
Delivering Quality Care: Treating Substance Abuse
Provider Access and Availability Survey
Closing Gaps in Care for Group Medicare Advantage (MA) Members
Reminder: Current Procedural Terminology (CPT^®) Codes Updated for Prior Authorization for Blue Cross Medicare Advantage^SM and Blue Cross Community Centennial^SM Medicaid programs
CMS-Required Training for Dual-Special Needs Plans
Required Cultural Competency Training Available Online
Reminder: Update your Enrollment Information

June 2021 — Read these articles and more...

COVID-19 Information for Providers
ClaimsXten^TM Quarterly Update Reminder
Current Procedural Terminology (CPT^®) Codes Updated for Prior Authorization
Pharmacy Program Updates: Quarterly Pharmacy Changes Effective July 1, 2021 — Part 1
BCBSNM Members Have New Mail Order and Specialty Pharmacies as of May 1, 2021
National Drug Code (NDC) Fee Schedule Change for Octagam (J1568)
Prepayment Reviews on Inpatient DRG Claims for BlueCard Members
EXL Health to Review Complex Claims July 1, 2021
Delivering Quality Care: Treating Substance Abuse
Current Procedural Terminology (CPT^®) Codes Updated for Prior Authorization for Blue Cross Medicare Advantage^SM and Blue Cross Community Centennial^SM Medicaid programs
CMS-Required Training for Dual-Special Needs Plans
Required Cultural Competency Training Available Online
Reminder: Update your Enrollment Information

May 2021 — Read these articles and more...

COVID-19 Information for Providers
Some Codes Removed from AIM^® Prior Authorization
Select Medication List to be Updated June 1, 2021
Pharmacy Program Updates: Quarterly Pharmacy Changes Effective April 1, 2021 — Part 2
Documentation and Coding: Major Depressive Disorder
Delivering Quality Care: Cervical Cancer Screening May Save a Life
Delivering Quality Care: Caring for the Colon
Provider Satisfaction Survey 2021
New Applied Behavior Analysis (ABA) Service Request Forms
CMS-Required Training for Dual-Special Needs Plans
Required Cultural Competency Training Available Online
Reminder: Update your Enrollment Information

April 2021 — Read these articles and more...

COVID-19 Information for Providers
Single Access Point for EFT and ERA Enrollments
Telehealth Place of Service Code Enabled
Health Care Quality: Blood Pressure Control – Speaking Out About the 'Silent Killer'
The CAHPS^® Survey: We All Play a Role
Updates Made to the Provider Reference Manual
CMS-Required Training for Dual-Special Needs Plans
Required Cultural Competency Training Available Online
Reminder: Update your Enrollment Information

March 2021 — Read these articles and more...

COVID-19 Information for Providers
BCBSNM will update CPT^® Codes for some outpatient services, added benefits with AIM Specialty Health^® (AIM) Effective April 1, 2021
CPT Category II Codes Can Help Close Care Gaps
Overpayment Recovery for Multiple Surgical Procedures
Pharmacy Program Updates: Quarterly Pharmacy Changes Effective April 1, 2021, Part 1
CMS-Required Training for Dual-Special Needs Plans
Updates made to the Blue Cross Community Centennial Section of the BCBSNM Provider Reference Manual
Required Cultural Competency Training Available Online
Reminder: Update your Enrollment Information

February 2021 — Read these articles and more...

COVID-19 Information for Providers
Documenting and Coding Guidance for Atrial Fibrillation
Documenting and Coding Guidance for Diabetes Mellitus
BCBSNM Federal Employee Program^® Annual Medical Record Data Collection for Quality Reporting — HEDIS Measurement Year (MY) 2020 Begins Feb. 1, 2021
New HEDIS^® Tip Sheets^* Behavioral Health HEDIS Measures: FUA and FUM
Outpatient Provider Incentive Program for Behavioral Health Follow-up Visit
Childhood Immunization Rates Fall Amidst Pandemic Fears
Clinical Practice and Preventive Care Guidelines Updated for 2020-2021
Pharmacy Program Updates: Quarterly Pharmacy Changes Effective Jan.1, 2021 — Part 2
Coverage for Contraception Act
CMS-Required Training for Dual-Special Needs Plans
Required Cultural Competency Training Available Online
Reminder: Update your Enrollment Information

January 2021 — Read these articles and more...

COVID-19 Information for Providers
Providers receiving bamlanivimab for free should not bill for the product
Reminder: Transition of Care: Preauthorization Changes from eviCore to AIM Specialty Health^® (AIM) for Some Members effective Jan. 1, 2021
Reminder: Use the AIM ProviderPortal for Pre & Post Service Reviews
Annual HEDIS^® Medical Record Review for Measurement Year 2020 to begin February 2021
BCBSNM will update CPT^® codes for some outpatient services, added benefits with AIM
Quality Health Standards — Prenatal and Postpartum Visits
Medicare adds benefit for members with inherited ovarian or breast cancer
Hospitals Must Provide Medicare Outpatient Observation Notice (MOON)
Obtain BCBSNM Patient ID Numbers Online via Availity^® — Now Available for Government Programs
Patients in the Qualified Medicare Beneficiary (QMB) Program Should Not Be Billed
Blue Cross Medicare Advantage Dual Care (HMO SNP) 2019 Program Summary
CMS Required Training for Dual Special Needs Plans
Coverage for Coronary Artery Calcium Scan for Cardiovascular Disease Risk Assessment
Required Cultural Competency Training Available Online

2020

December 2020 — Read these articles and more...

COVID-19 Information for Providers
BCBSNM Moving Preauthorization Duties from eviCore to AIM Effective Jan. 1, 2021, for Some Members
BCBSNM Preauthorization Changes Beginning Jan. 1, 2021
Revision to Specialty Medication Administration Site of Care Policy, Effective Jan. 1, 2021
Availity Claim Status Tool Now Available for All BCBSNM Members
Updates Made to the Provider Reference Manual
Billing Reminders for Psychological and Neuropsychological Testing
New HEDIS^® Tip Sheets for Behavioral Health HEDIS Measures: APM and UOP
New Electronic Duplicate Claim Rejections for Commercial Claims Effective Nov. 14, 2020
Verify Multiple Patient's Eligibility and Benefits Coverage via Availity^®
View, Download and Print the BCBSNM Member's ID Card Online via the Availity Provider Portal
Are Utilization Management Decisions Financially Influenced?
Pharmacy Program Updates: Quarterly Pharmacy Changes Effective Oct. 1, 2021, Part 1
Health Benefits of Collaborating with Eye Care Professionals
Importance of Hospital Discharge Summaries Both Empowers the Members and Informs Primary Care Providers
2020 Reminder to Encourage Regular Pre- and Post-Natal Care
2021 Blue Cross Medicare Advantage Preauthorization Updates
CMS-Required Training for Dual-Special Needs Plans
2021 Blue Cross Community Centennial Prior Authorization Updates
Our Medicaid Quality Improvement Program
Required Cultural Competency Training Available Online

November 2020 — Read these articles and more...

COVID-19 Information for Providers
Clinical Practice Guidelines for the Metabolic Syndrome and Management of Overweight and Obesity in Adults
Submit Electronic Professional and Facility Claims via the Availity^® Provider Portal
Availity Provider Portal Offerings
Availity Claim Status Tool Now Available for All BCBSNM Members
Updates and Reminders: Submit Predetermination of Benefits Submission via Availity
Telemedicine — Future State
Are You Using These Shared Decision‑Making Aids?
BCBSNM Names New President
Provider Finder^® Gets an Upgrade
CMS-Required Training for Dual-Special Needs Plans
Preparing for the 2020-2021 Flu Season: Administering Flu Vaccines During the COVID‑19 Pandemic
Required Cultural Competency Training Available Online

October 2020 — Read these articles and more...

COVID-19 Information for Providers
In-Home Test Kits for Diabetics
Share Your Medication Assisted Treatment Designation
Blue Distinction^® Message via the Availity^® Eligibility and Benefits Results
Verify Procedure Code Preauthorization Requirements and Submit the Request via Availity
Outpatient Provider Incentive Program for Behavioral Health Follow‑up Visit
Pharmacy Program Updates: Quarterly Pharmacy Changes Effective Oct. 1, 2020, Part 2
Provider Finder^® Gets an Upgrade
CMS-Required Training for Dual-Special Needs Plans
In-Home Diabetes Monitoring Tests Coming to Select Blue Cross Community Centennial^SM Members
Required Cultural Competency Training Available Online

September 2020 — Read these articles and more...

COVID-19 Information for Providers
Reminder for Billing Point-of-Use Convenience Kits
Submit Predertermination of Benefits Requests via Availity
iExchange Deactivated on Aug. 17, 2020
Two New Behavioral Health Measures Tip Sheets
Outpatient Provider Incentive Program for Behavioral Health Follow-up Visit
NMSU, BCBSNM Partner to row Health Care Workforce
Pharmacy Program Updates: Quarterly Pharmacy Changes Effective Oct. 1, 2020, Part 1
BCBSNM Medical Policies
Imaging Studies for Low Back Pain for FEP Members
CMS-Required Training for Dual-Special Needs Plans
Threshold Amount for Claims Review for Blue Cross Community Centennial Members
Required Cultural Competency Training Available Online

August 2020 — Read these articles and more...

COVID-19 Information for Providers
Federal Agencies Extend Timely Filing and Appeals Deadlines
Colorectal Cancer Screening at Home
Overpayment Recovery Process for Contracted Providers – Changes as of Jan. 1, 2020
COVID-19 Coverage Updates for Medicare Providers
CMS Payment Adjustments for Medicare Providers
Blue Cross Medicare Advantage Prior Authorization Updates effective Sept. 1, 2020
Addition of New Prior Authorization Requirements for Blue Cross Community CentennialSM Members
CMS-Required Training for Dual–Special Needs Plans
Required Cultural Competency Training Available Online

July 2020 — Read these articles and more...

COVID-19 Information for Providers
BCBSNM will update CPT Codes for some preauthorization Services
Are you submitting claims correctly for medications that come in additional packaging?
Pharmacy Program Updates: Quarterly Pharmacy Changes Effective July 1, 2020 – Part 2
New Email Address for Prior Authorization Appeals Effective July 1, 2020
CMS-Required Training for Dual–Special Needs Plans
Required Cultural Competency Training Available Online

June 2020 — Read these articles and more...

COVID-19 Information for Providers
Blue Cross and Blue Shield of New Mexico Contributes $1 million To Aid New Mexico's COVID-19 Response
Learn how to Submit a Prior Authorization through the eviCore Web Portal
Calls to Electronic Commerce Services will be Redirect to Email as of June 15, 2020
CMS-Required Training for Dual-Special Needs Plans
Required Cultural Competency Training Available Online

May 2020 — Read these articles and more...

COVID-19 Information for Providers
Obtain your Provider Claim Summary (PCS) Online — PCS Mailing Discontinuation as of May 4, 2020
Remember to use In-Network Laboratories
Stand Up and Be Counted
CMS-Required Training for Dual-Special Needs Plans
New Annual Wellness Visit Resources for Medicare Providers
Required Cultural Competency Training Available Online

COVID-19 Special Edition Blue Review - A digest of information for providers

April 2020 — Read these articles and more...

Three New ClaimsXtenTM Rules to be Implemented June 2020
Obtain Your Provider Claim Summary (PCS) Online — PCS Mailing Discontinuation as of May 4, 2020
Pharmacy Program Updates: Quarterly Pharmacy Changes Effective April 1, 2020, Part 1
CMS-Required Training for Dual-Special Needs Plans
CMS Star Ratings Matter: Survey to Assess Medicare Advantage Members’ Experiences
Required Cultural Competency Training Available Online
Telemedicine Grant Funding Opportunity for Contracted Providers
2020 Centennial Care Performance Measures
Updates Made to the Blue Cross Community Centennial Section of the BCBSNM Provider Reference Manual

February/March 2020 — Read these articles and more...

Two New ClaimsXten^TM Rules to be Implemented in 2020
New BCBSNM 837 Commercial Claim Validation Edits
Prior Authorization Changes for ID Prefixes BBE, BHP, BNK, BRG and BYR
Shared Decision Making Aids Available Online
Introducing a New Preauthorization Submission Tool via Availity^® Provider Portal
2020 Annual HEDIS^® Medical Record Review Begins February 2020
CMS Required Training for Dual Special Needs Plans
Thank You: RADV/IVA Project 2019
Updates Made to the Medicare Advantage Section of the Provider Reference Manual
Required Cultural Competency Training Available Online
2019 Medical Record Review
Pregnant Women and Vaccines

January 2020 — Read these articles and more...

Two New ClaimsXten^TM Rules to be Implemented in 2020
New HEDIS^® Behavioral Health Measures Tip Sheets
Reminder that Laboratory Benefit Level Changes for Some Members this Month
CMS-Required Training for Dual-Special Needs Plans
Reminder: Medicare Providers May Not Bill Participants in the Qualified Medicare Beneficiary Program
Medicare Advantage 30-Day Facility Readmissions Review
National Coordination of Care^SM Program to Serve Group Blue Cross Medicare Advantage (PPO)^SM Members
Annual Reminder: Medicare Outpatient Observation Notice Required
Updates Made to the Medicare Advantage Section of the Blues Provider Reference Manual
Required Cultural Competency Training Available Online
Changes to the HEDIS 2020 Prenatal and Postpartum Care Measure
Survey Shows Medicaid Members Give Their Providers High Ratings
Our Medicaid Quality Improvement Program

2019

December 2019 — Read these articles and more...

Coordinating Care Between Behavioral Health and Medical Providers
Referring Members to In-Network Laboratories
Availity^® Remittance Viewer Tool Upgrade
New Online Enrollment Process for 835 EFT & ERA through the Availity Provider Portal
New Programs Help Members Lead Healthier Lives
Pharmacy Program Updates: Quarterly Pharmacy Changes Effective January 1, 2020 – Part 2
Recommendations and Reminders for Eye Care Professionals
Information for Primary Care Providers – Importance of Hospital Discharge Summaries
CMS Required Training for Dual Special Needs Plans
2019 Updates in Pre- and Post-Natal Care Information to Support Effective Coordination and Continuity of
Reminder of Change to the Preservice Appeals Process for your Medicare Patients Covered by BCBSNM
Medicare Advantage: Electronic Payment Summary Now Available for 835 ERA Receivers
Tips for Providing Reimbursable Telemedicine Services to BCBSNM Members
Blue Cross Community Centennial Quality Toolkit Updates

November 2019 — Read these articles and more...

Antibiotic Use in Outpatient Settings
Collaborating to Reduce Opioid Abuse
Be Covered — Increasing Coverage for the Uninsured and Underinsured
What You Need to Know About the 2019-2020 Flu Season
Are Utilization Management Decisions Financially Influenced?
Pharmacy Program Updates: Quarterly Pharmacy Changes Effective January 1, 2020 — Part 1
NDC Fee Schedule Change for Fulphila (J5108) and Udenyca (J5111) Effective January 1, 2020
Updates Made to the Provider Reference Manual
CMS Required Training for Dual Special Needs Plans
New Names and ID Cards for Group Medicare Plans
2020 Blue Cross Medicare Advantage Preauthorization Updates
Billing and Documentation Guidelines for Urine Drug Tests
2020 Blue Cross Community Centennial Prior Authorization Updates

October 2019 — Read these articles and more...

HHS-RADV/IVA – Frequently Asked Questions
Addition of New Prior Authorization Requirements for New Mexico Members
A Change in the Coding of Physical Medicine Service Units: Time Based Measurement Standard to Follow AMA
Measure and Document Body Mass Index (BMI)
BCBSNM to Review Implant Claims from Stand Alone ASCs
Pharmacy Program Updates: Quarterly Pharmacy Changes Effective October 1, 2019 — Part 2
Laboratory Benefit Level Change
CMS Required Training for Dual Special Needs Plans
Changes to Medicare Advantage Payment Models for Skilled Nursing Facility and Home Health Care Claims
Medicare PTAN and Medicaid Numbers/Letters Required for Network Inclusion
New Program Notification: Opioid Diagnosis Code Required at Pharmacy
Screening for Clinical Depression Initiative
Behavioral Health and Addiction TeleECHO Program

September 2019 — Read these articles and more...

FEP Blue Focus Prior Authorization Reminder
New Online Case and Credentialing Status Checkers
New Addresses for Claims Overpayment Returns
Respond Electronically to medical Record Requests for Quality and risk Adjustment, and soon Claims, via Availity Provider Portal
Well–Child Visits Within the First 15 Months of Life (W15)
New and Exciting Functionality Coming to the Claim Research Tool (CRT) via Availity Provider Portal
IVR Phone System: Consolidated Benefit Response
Medicare Advantage Updates to Provider Finder Coming in September 2019
CMS–Required Training for Dual-Special Needs Plans

August 2019 — Read these articles and more...

Pharmacy Program Updates: Quarterly Pharmacy Changes Effective July 1, 2019
Reminder: Verify Procedure Code Preauthorization Requirements Online
Member Letters Have a New, Simpler Look
CMS Required Training for Dual-Special Needs Plans
Notice of Change to Preservice Appeals Process for your Medicare Patients Covered by BCBSNM
Blue Cross Community Centennial^SM Quality Toolkit Updates

July 2019 — Read these articles and more...

Availity^® Claim Research Tool Offers Enhanced Claim Status Results
Provider Signature Attestations for the HHS Risk Adjustment Data Validation Program
A Call to Immunize New Mexico Children
Changes to Behavioral Health Claim Review
Out of State Electronic Remittance Advice (ERA) Enrollment Notification
CMS Required Training for Dual-Special Needs Plans
Removal of Prior Authorization Requirements for your Medicare Advantage Patients
Automated Phone System Offers More Service Options for Medicare Advantage

June 2019 — Read these articles and more...

Pharmacy Program Updates: Quarterly Pharmacy Changes Effective July 1, 2019
In–home Colorectal Cancer Screening Test Provided to Select Members
Screening and Treatment for Hepatitis C
Thank You for Participating in the HEDIS Medical Records Project
Helping Patients Shop for Cost-Effective Knee/Hip Replacements
Changes to Specialty Drugs Preauthorization List: Always Check Preauthorization Requirements
CMS–Required Training for Dual-Special Needs Plans
Reporting On-Demand Application Now Available for Government Programs via Availity^® Provider Portal

May 2019 — Read these articles and more...

BCBSNM is Continuing our Efforts to Validate Data for Our Provider Directories
Living365^® "Living with Diabetes" Health Education Classes Available for All Blue Cross and Blue Shield of New Mexico Members
Imaging Studies for Low Back Pain
Making an Impact in Our Community
Check Eligibility and Benefits: Don't Skip This Important First Step!
May is Mental Health Month: Talk to Your Patients About Depression
BCBSNM Now Offers a Choice in Pharmacies for Specialty Medications
CMS-Required Training for Dual-Special Needs Plans

April 2019 — Read these articles and more...

Changes to the Three-Character Prefix on Member ID Cards
Check you Patients’ Behavioral Health Preauthorization Requirements
Save Time by Using eviCore Web Portal for Preauthorization Requests
Pharmacy Program Updates: Quarterly Pharmacy Changes Effective April 1, 2019
Medical records Request Reminder
Clinical Payment and Coding Policies
CMS-Required Training for Dual-Special Needs Plans
Change in Reject Notification for Invalid National Drug Codes (NDCs) Used on Electronic Medicare Advantage Claims

March 2019 — Read these articles and more...

BCBSNM’s Payer Spaces Updates in Availity^® Provider Portal
We Need Your Help to Improve Behavioral Health Care Access!
Referring Members to In-Network Laboratories
Clinical Payment and Coding Policies
Importance of Adult Body Mass Index (BMI) Measurement and Management
BCBSNM Will No Longer Accept Paper Onboarding Forms for Certain Provider Types Effective May 1, 2019
Are You Using These Shared Decision-Making Aids?
CMS-Required Training for Dual-Special Needs Plans
Annual Reminder: Medicare Outpatient Observation Notice (MOON) Required Training for Dual-Special Needs Plans
Government Programs: Verifying Claim Status in the Availity Provider Portal
Change in Preferred Hepatitis C Agent for Blue Cross Community Centennial Members, Effective March 1, 2019
2019 HSD Behavioral Health Policy and Billing Manual and Supplement 19-04
2019 Blue Cross Community Centennial Prior Authorization Updates

February 2019 — Read these articles and more...

Pharmacy Program updates: Quarterly Pharmacy Changes Effective Jan. 1, 2019
We Need Your Help to Improve Behavioral Health Care Access!
2019 Standards of Medical Care in Diabetes
Why Doctors Review Health Insurance Claims
Clinical Payment and Coding Policies
CMS–Required Training for Dual-Special Needs Plans
2018 Medical Record Review
2019 Blue Cross Community Centennial Prior Authorization Updates
Reminder: GuidingCare^® is Now Available for New Mexico Medicaid Providers

January 2019 — Read these articles and more...

Automated Phone system Change for Behavioral Health Services
Close HEDIS^® Gaps Easily Through the Availity Provider Portal
Behavioral Health Forms Get a Facelift
2019 Annual HEDIS medical Record Review Begins February 2019
Notification of Annual Benefit Updates
Clinical Payment and Coding Policies
CMS-Required Training for Dual-Special Needs Plans
New Opioid Drug Management Program for Medicare Members
New Concurrent Opioid and Benzodiazepine Prior Authorization Program for Blue Cross Community Centennial Members

2018

December 2018 — Read these articles and more...

2019 Benefit Prior Authorization Changes: eviCore^® Training, Reminders and Resources
Additional Clinical Payment and Coding Policies
Responding to Electronic Quality and Risk Adjustment Medical Record Requests via Availity^TM Provider Portal
Cardiology Services No Longer Require Prior Authorization for Blue Cross Medicare Advantage, Effective Dec. 17, 2018
Introducing FEP Blue Focus^SM
Change in Preferred Diabetic Testing Supplies for Blue Cross Community Centennial^SM Members, Effective Jan. 1, 2019
Performance Measure – Timeliness of Postpartum Care

November 2018 — Read these articles and more...

Importance of Adult Body Mass Index Measurement and Management
BCBSNM Prior Authorization Changes Beginning Jan. 1, 2019
Specialty Pharmacy Infusion Site of Care: Prior Authorization Requirements
2019 Blue Cross Community Centennial Prior Authorization Updates
Required Cultural Competency Training Available Online
Proper Claim Filing Procedures for Blue Cross Community Centennial Behavioral Health Providers
2019 Blue Cross Medicare Advantage Prior Authorization Updates
Government Programs: Interpreting the ‘PLB’ Segment on the 835 Electronic Remittance Advice (ERA)
CMS-Required training for Dual-Special Needs Plans
FEP Benefits Changes for Infliximab Effective Jan. 1, 2019
Documentation During Pregnancy
Importance of Hospital Discharge Summaries
Referring Diabetic Patients for Annual Eye Exams

October 2018 — Read these articles and more...

Prepping for the 2018-2019 Flu Season
New Application Process for Joining Out Networks
‘Annual Visit’ Campaign Continues, Proper Coding is Crucial
Screening and Management for Clinical Depression
Important Reminder: Rendering, Ordering, Attending and Referring Providers Must Enroll with NM Medicaid for Blue Cross Community Centennial Claims

September 2018 — Read these articles and more...

Quarterly Pharmacy Updates Effective July 1, 2018
Amniotic Membrane and Amniotic Fluid Products May Be Considered Experimental, Investigational and/or Unproven
Working Together To Improve The Member-Provider Experience: Member Concerns About Genetic Testing Costs And Coverage
New Lactation Consultation Designation Added To Demographic Change Form
New Application Process For Joining Our Networks
Important Reminder: Claims Will Deny If Rendering NPIs Are Not On File With BCBSNM
Important Reminder: Inpatient Services Require Prior Authorization
Government Programs: Improving Claim-Related Processes and EDI Transactions
Tips for Providing Reimbursable Telemedicine Services to Blue Cross Community Centennial members
Important Reminder: Rendering, Ordering, Attending and Referring Providers Must Enroll with NM Medicaid for Blue Cross Community Centennial Claims

August 2018 — Read these articles and more...

Appropriate Use of Opioids Program, Launched Aug. 1, 2018
Voluntary Recall of medications Containing the Valsartan Active Ingredient
Annual Visit Campaign Leads to Importance of Proper Coding
Making the Health Care System Work better Together
2019 Blue Cross Centennial Care Contracts
New Mexico Medicaid Fee Schedule for Behavioral Health Providers Effective July 1, 2018

July 2018 — Read these articles and more...

High-Dose Influenza Vaccine Guidelines
Working Together to Improve the Member-Provider experience: Member Concerns about “Up Front” Payments
Making the Health Care System Work Better Together
Annual Training for Medicaid Providers
CMS0Required Training for Dual-Special Needs Plans
Prohibition on Billing Dually Eligible Members Enrolled in the Qualified Beneficiary Program

June 2018 — Read these articles and more...

Select Specialty Medications to Transition to Accredo Specialty Pharmacy
Addressing What Matters: How BCBSNM is Tackling the Opioid Crisis
V55 Claim Denial Resolution
HCPCS Mammogram Code Replacement
Reminder: Inpatient Services Require Prior Authorization
New eviCore Email Notification for Utilization Management Decisions
Quickly, Efficiently Manage and Respond to Coding Opportunities Online Through the Availity Provider Portal
Updates Made to Blue Cross Community Centennial Provider Reference Manual
Nursing Facility Bed Hold Days
Additional CLIA-Waived Codes

May 2018 — Read these articles and more...

Quarterly Pharmacy Changes Effective Apr. 1, 2018
Services Rendered by Providers to Related Members and/or Self
Making the Health Care System Work Better Together
Member Concerns About DME – Working Together to Improve the Member-Provider Experience
Critical Incident Reporting
2018 Billing and Documentation Guidelines for Urine Drug Tests

April 2018 — Read these articles and more...

Updated Forms Available on Provider Website
Quickly Manage and Respond to Risk Gaps Through the Availity Web Portal
BCBSNM Approves Coverage of new Shingles Vaccine: Shingrix
Cancer Prevention: The Added Value in Adolescent Immunizations
Working Together to Improve the Member-Provider Experience: Choosing the Best Direction
Updated Online NDC Units Calculator Tool Now Available
Fall Prevention: Resources for Providers and members
Rendering, Ordering, Attending and Referring Provider Information Required for Blue Cross Community Centennial Claims
CareLink New Mexico Integrates Physical and Behavioral Health Services

March 2018 — Read these articles and more...

Interpreting the “PLB” Segment on the 835 ERA
Making the Health Care System Work Better Together
Quarterly Pharmacy Changes Effective Jan. 1, 2018
March into Colon Cancer Awareness Month
Behavioral Health: Let’s Talk About It!
New Medicaid ID Numbers for Members

February 2018 — Read these articles and more...

Availity^TM Claim Research Tool Offers Enhanced Claim Status Results
Electronic Commerce Services – Hours of Operation Update
BCBSNM Awarded Centennial Care 2.0 Contract
Hypertension: Resources for Providers and Members
Other Provider Resources

January 2018 — Read these articles and more...

2018 Holiday Schedule Reminders for 835 and 837 Transactions
Notice of Annual Benefit Updates
Pharmacy Benefit Tips
Online Magazine Spotlight: How Health Care Veterans Foster (and Learn from) Startups
Skilled Nursing Facility (SNF) Benefit Change for FEP Members

2017

December 2017 — Read these articles and more...

2018 Additional Preauthorization Requirements
"Pulling It All Together" - Colon Cancer Screenings Goal: 80% Participation by 2018
Reimbursement Policy Update Effective Jan. 1, 2018
Pharmacy Program Updates: Quarterly Pharmacy Changes Effective Oct. 1, 2017
2018 Blue Cross Community Centennial^SM Preauthorization Updates
Service Spotlight: Special Beginnings^® Maternity Program
Updated Diagnosis Related Group Rates
New Dental Varnish Billing Code
Survey Shows Medicaid members Give Their Providers high Ratings
Looking Back at HEDIS^®: Results for HEDIS 2015, 2016 and 2017
Our Medicaid Quality Improvement Program
Electronic Visit Verification (EVV) Claim Entries Require Supporting Documentation
2018 Blue Cross Medicare Advantage^SM Preauthorization Updates
In-Home FOBT/FIT & HbA1c test Kits for FEP Members
2018 FEP utilization Management Clinical Guideline 002: Inpatient Skilled Nursing Facility Care

November 2017 — Read these articles and more...

2018 HEDIS^® Medical Record Review Begins February 2018
New medical Record Retrieval Vendor for Out-of-Area Blue Plan Member Records
New Online Magazine Spotlights Emerging Episodes of Care Payment Model
BCBSNM Celebrates LGBTQ Inclusion
Important Information on ABA Forms, Authorizations and Payment
Billing for Binaural Hearing Aids
How to Find BCBSNM Resources in Availity^TM Payer Spaces
Adhering to Vaccination Guidelines
Make Your Focus Clear on Eye Care with Retinopathy Screening
Important Notice Regarding Allergy Services
Documentation Guidelines for Laboratory Audit/Review
Operational Effectiveness: Better and Faster Ways to Do Business Together
National Diabetes Month 2017
Living 365SM Diabetes Education Classes
Cold Weather Asthma: Prevention Through Education
FEP Plan Update

October 2017 — Read these articles and more...

Antidepressant Medication Management Initiative
Flu Vaccines, Billing, and CPT Codes
Examining Variability in Pricing Solutions Through Shared Data

September 2017 — Read these articles and more...

BCBSNM Website
Adult BMI Assessment
Annual Well-Child Visit Important for Children and Caregivers
Identifying and Prescribing Correct Glucose Meter Test Strips
HSD No Longer Issuing Separate Medicaid Cards for MCO-Enrolled Members
Blue Cross Medicare Advantage: Electronic Claim Submission Edits
Government Programs: Claims Rejecting as Duplicate Submissions
Prohibition on Billing Dually-Eligible Members Enrolled in the Qualified Medicare Beneficiary Program

August 2017 — Read these articles and more...

BCBSNM Website
Receipt of Credentialing Application Notification
ClaimsXten^TM Quarterly Updates
Code Auditing Enhancement
New Claim Payment and Remittance Resources
EFT and ERA Update for Non-Contracted Government Programs Providers
Integration of Prime Therapeutics^® and Walgreens^® Specialty Pharmacy and Mail-Order Services
Where Data Flows, Improvements are Bound to Follow
Blue Cross Community Centennial Changes, Effective July 21, 2017
Submitting Electronic Claims for Blue Cross Community Centennial Members
Pharmacy Change for blue Cross Community Centennial Members Effective Sept. 1, 2017
Antidepressant Medication Management Initiative

July 2017 — Read these articles and more...

BCBSNM Website
ClaimsXten^TM Announces Software Version Upgrade
Utilization Management Determinations
Insurers Required by CMS to Conduct ACA Risk Adjustment Program Audit
Appointment Availability and Access Guidelines
Receipt of Credentialing Application Notification
Benefit Information Accessible in the IVR Phone System
Online Enrollment Options in Availity^TM
Additional Benefit Categories Contained in IVR Phone System
Careful Documentation Paves the Way for Accurate Coding Capture
Screening for Hepatitis C
Appointment Availability and Access Guidelines for Blue Cross Community Centennial Members
Blue Cross and Blue Shield of New Mexico Managed Care Program Blue Cross Community Centennial Changes, Effective May 20, 2017
Federal Employee Program Self-Measured Blood Pressure Monitoring
Member Rights and Responsibilities

June 2017 — Read these articles and more...

BCBSNM Website
ClaimsXten^TM Announces Software Version Upgrade
Receipt of Credentialing Application Notification
Utilization Management Determinations
The Importance of Care Coordination
Insurers Required by CMS to Conduct ACA Risk Adjustment Program Audit
Benefit Information Accessible in the IVR Phone System
Online Enrollment Options in Availity^TM
Appointment Availability and Access Guidelines
Receipt of Credentialing Application Notification
Blue Cross and Blue Shield of New Mexico Managed Care Program Blue Cross Community Centennial Changes, Effective May 20, 2017
Member Rights and Responsibilities
Billing Medicaid Members
New Medicare Preauthorization Requirements through eviCore
Federal Employee Program Self-Measured Blood Pressure Monitoring

May 2017 — Read these articles and more...

BCBSNM Website
ClaimsXten^TM Quarterly Updates
ClaimsXten^TM Announces Software Version Upgrade
Utilization Management Determinations
The Importance of Care Coordination
Insurers Required by CMS to Conduct ACA Risk Adjustment Program Audit
Benefit Information Accessible in the IVR Phone System
Online Enrollment Options in Availity^TM
Appointment Availability and Access Guidelines
Receipt of Credentialing Application Notification
Blue Cross and Blue Shield of New Mexico Managed Care Program Blue Cross Community Centennial Changes, Effective May 20, 2017
Member Rights and Responsibilities
Billing Medicaid Members
New Medicare Preauthorization Requirements through eviCore

April 2017 — Read these articles and more...

BCBSNM Website
ClaimsXten^TM Quarterly Updates
Overcoming Barriers to Colorectal Cancer Screening
The Importance of Care Coordination
Insurers Required by CMS to Conduct ACA Risk Adjustment Program Audit
LifeTimes^® Member Newsletter Offers Tips on Preventing Heart Attacks and Strokes
Appointment Availability and Access Guidelines
Provider Claim Summary Paper Mailing Discontinuance: Effective Date Delay
Receipt of Credentialing Application Notification
Member Rights and Responsibilities
Billing Medicaid Members
New Medicare Preauthorization Requirements through eviCore

March 2017 — Read these articles and more...

ClaimsXten^TM Quarterly Updates
Kicking the Habit: Helping to Overcome Opioid Addiction in America
How are You Diagnosing Hypertension
Availity^TM Claim Research Tool Offers Enhanced Status Results
Talking with Health Services Staff
Utilization Management Determinations
Receipt of Credentialing Application Notification
Billing Medicaid Members
Member Rights and Responsibilities
New Medicare Preauthorization Requirements through eviCore

February 2017 — Read these articles and more...

Annual Medical Record Data Collection for Quality Reporting begins February 1, 2017
Receipt of Credentialing Application Notification
80% by 2018 Will you commit?
Preterm Labor Prevention Program
Additional Code-auditing Software Scheduled for Implementation as of April 30, 2017

January 2017 — Read these articles and more...

Opiates
LARC use in Adolescents 15-19
BCBSNM Vision Plan Transitions to EyeMed - Revisions

2016

December 2016 Learn more about third-party links — Read this article and more...

Avoiding Administrative Claim Denials
Coordination of Care Between Medical and Behavioral Health Providers
CMS Compliance Program Training Requirements
CVP Implementation Notice
Provider Payment and Provider Credentialing Requirement
Annual Medical Record Data Collection for Quality Reporting begins Feb. 1, 2017

November 2016 — Read these articles and more…

ClaimsXtenTM Quarterly Updates
Welcome to Concussion Season
Flucelvax Quadrivalent Billing Update
Annual Medical Record Data Collection

October 2016 — Read these articles and more…

Diabetes Coordination of Care and Blood Glucose Meter Program Updates
New Preauthorization Requirement for Applied Behavioral Analysis
Member Rights and Responsibilities
Special Beginnings^® Maternity Program

August 2016 — Read these articles and more…

CDC Guidelines for Prescribing Opioids for Chronic Pain
New Mexico Statewide Pharmacy Standing Order for Naloxone
Preventive Care Guidelines for Clinicians
Centennial Care Reminder - Update your Provider Enrollment Information

Due to production delays, the Blue Review was not published in April through July. The monthly publication resumed in August 2016.

March 2016 — Read these articles and more…

Correction - Telemedicine Reimbursement
Screening for Hepatitis C
Pediatric Asthma Intervention Project Results

February 2016 — Read these articles and more…

New Products Offer More Choices and Potential Savings for BCBSNM Members
ICD-10 'Coding Basics' Video and Other Resources
Advance Directives — Not Just a Good Idea

January 2016 — Read these articles and more…

Implementation Reminder: Three New Facility Rules for ClaimsXten™, Effective Feb. 22, 2016
Provider Medicare Enrollment Information
Reduction in Prior Authorization Requirements

Blue Review — Provider Newsletter