Our Blue Review provider newsletter is released monthly so that you and your staff have the latest news on claims and billing, federal mandates, medical policies, condition management programs, practice guidelines, formulary/drug list updates, Medicaid, BlueCard, and educational webinars.
Additional Resources:
September 2023 — Read these articles and more...
- Transition from required Prior Authorization to Recommended Clinical Review Effective Sept. 18, 2023
- Reporting On-Demand via Availity® Essentials is Now Named Provider Claim Summary
- Shared Decision-Making Aids Can Help Guide Care Choices
- Claim Editing Changes for Emergency Department Services Coming Nov. 1, 2023
- Submitting Claims for Infertility Services
- Clinical Payment and Coding Policy Updates
- Pharmacy Program Updates: Quarterly Pharmacy Changes Effective Oct. 1, 2023 — Part 1
- Medical Records Reminder for Out-of-Area Medicare Advantage Members
- Expiration of the Public Health Emergency
- New Mexico Medicaid Provider Engagement Forum
August 2023 — Read these articles and more...
- Updates made to the Provider Reference Manual
- Webinar on Coding for Morbid and Severe Obesity
- Introducing Claim Reconsideration Requests via Availity® Essentials
- Prior Authorization Codes Updated, Effective Oct. 1, 2023
- PEAQSM Physician Performance Insight Reports are Coming Soon
- In-Home Test Kits for Colorectal Cancer Screening
- Statin Therapy for Patients with Cardiovascular Disease and Diabetes
- See Our Revised Preventive Services Clinical Payment and Coding Policy Effective July 1, 2023
- Clinical Payment and Coding Policy Updates
- Direction from Centers for Medicare & Medicaid Services (CMS) regarding enrollment requirements for prescribing pharmacists or pharmacy providers under Medicaid
- Pharmacy Program Updates: Quarterly Pharmacy Changes Effective July 1, 2023 — Part 2
- Current Procedural Terminology (CPT®) Codes Updated for Prior Authorization for Medicare Oct. 1
July 2023 — Read these articles and more...
- Letter of Direction (LOD) #85 — Community Benefit Provider Audits
- Updates made to the Provider Reference Manual
- Webinars on Cross-Cultural Care Offer Continuing Education Credit
- Blue Community HMO NetworkSM (CNN) — Individual On and Off Exchange Plans
- New Availity® Eligibility & Benefits Experience
- Provider Access and Availability Survey
- Member Rights and Responsibilities
- Provider Rights and Responsibilities
- ClaimsXtenTM Announces Software Version Upgrade
- Catch Up on Routine Vaccines and Well-Child Visits
- Clinical Payment and Coding Policy Updates
- Prior Authorization Codes Updated, Effective July 1
- Current Procedural Terminology (CPT®) Codes Updated for Prior Authorization for Medicare and Medicaid Programs, July 1
- Blue Cross Medicare Advantage Dual Care Plus (HMO SNP)SM 2021 Program Summary
- Medicare Providers May Treat Medicare Advantage Flex and Group Medicare Advantage Open Access PPO Members
June 2023 — Read these articles and more...
- PEAQSM Provider Performance Insights Coming Soon
- BlueApprovRSM Expedites Medical Surgical, Pharmacy and Behavioral Health Prior Authorization — Attend a Training
- Coverage for Telemedicine Services when the Public Health Emergency Ends May 11
- Updates made to the Provider Reference Manual
- Earn Continuing Education Credit at a Webinar on Avoiding Inappropriate Antibiotic Use
- ClaimsXtenTM Quarterly Update Effective August 21, 2023
- 2023 NM Annual NDC Drug Fee Schedule Impact and Timeline
- Helping Our Members Manage Diabetes
- See our New Clinical Payment and Coding Policy for Outpatient Facility Services that Overlap During an Inpatient Stay
- Clinical Payment and Coding Policy Updates
- Members Can Now Access Network of Pharmacies at Accredited Cystic Fibrosis Treatment Centers
- Pharmacy Program Updates: Quarterly Pharmacy Changes Effective July 1, 2023
- Updates Made to the Blue Cross Medicare Advantage Provider Reference Manual
- Medical Records Reminder for Out-of-Area Medicare Advantage Members
- Updates Made to the Blue Cross Community Centennial Provider Reference Manual
May 2023 — Read these articles and more...
- BlueApprovRSM Expedites Medical Surgical, Pharmacy and Behavioral Health Prior Authorization — Attend a Training
- Updates made to the Provider Reference Manual
- Webinar on Coding for Chronic Kidney Disease
- Annual Regulatory Survey of BCBSNM Provider Directories
- Prior Authorization Codes Updated, Effective July 1, also watch for Medical Oncology Portal Enhancements
- Current Procedural Terminology (CPT®) Codes Updated for Prior Authorization for Medicare and Medicaid programs, July 1
- New Support Program for Members with Kidney Disease
- Track Care Visits During and After Pregnancy
- See our New Three-day Payment Policy for Outpatient Services Prior to an Inpatient Admission
- Clinical Payment and Coding Policy Updates
- Behavioral Health Consultations During Hospitalization Can Improve Outcomes
- Pharmacy Program Updates: Quarterly Pharmacy Changes Effective April 1, 2023 — Part 2
- 2022 Medical Record Review
April 2023 — Read these articles and more...
- AIM Specialty Health Changes Its Name to Carelon Medical Benefits Management
- BCBSNM Engaged Hospital Service Corporation for Site Visits
- Earn Continuing Education Credit through Webinar on Opioids
- See Changes to our Existing Inpatient Readmission Policy for Some Commercial Members
- Monitoring Children Using ADHD Medications
- Caring for Substance Use Disorders
- Screening and Follow-Up Care for Maternal Mental Health
- New for 2023: Specialty Pharmacies Added In-Network
- Pharmacy Program Updates: Quarterly Pharmacy Changes Effective January 1, 2023 — Part 2
March 2023 — Read these articles and more...
- New Blue ApprovRSM Expedites Some Prior Authorizations — Attend a Training to Learn More
- Updates made to the Provider Reference Manual
- Earn Continuing Education Credit through Webinar on Bipolar Disorder
- Cultural Awareness Webinars: Earn Continuing Education Credit
- Verify Your Directory Details Every 90 Days
- Provider Onboarding Form Requirement
- Closing Gaps in Colon Care
- Clinical Payment and Coding Policy Updates
- Quality Care: Screening for Depression
- Pharmacy Program Updates: Quarterly Pharmacy Changes Effective April 1, 2023 — Part 1
- Help Close Gaps in Care for Group Medicare Advantage Members
- Survey to Assess Medicare Advantage Members’ Experiences
- Updates Made to the Blue Cross Medicare Advantage Provider Reference Manual
- COVID-19 Public Health Emergency Ending
- New Mexico Human Services Department Issues Supplement #22-12
- Updates Made to the Blue Cross Community Centennial Provider Reference Manual
February 2023 — Read these articles and more...
- FEP® Annual Medical Record Data Collection for Quality Reporting — HEDIS®
- Updates made to the Provider Reference Manual
- Prior Authorization Codes Updated, Effective April 1
- Current Procedural Terminology (CPT®) Codes Updated for Prior Authorization for Medicare and Medicaid programs, April 1
- ClaimsXtenSM Quarterly Update Effective April 17, 2023
- Supporting Heart Health Equity
- Predetermination is now Recommended Clinical Review
- Clinical Payment and Coding Policy Updates
- Inflation Reduction Act to Impact Insulin and Vaccine Costs for Medicare Members
- Blue Cross Medicare Advantage Dual Care Plus (HMO SNP)SM 2020 Program Summary
- Updates Made to the Blue Cross Medicare AdvantageSM Provider Reference Manual
- Updates Made to the Blue Cross Community CentennialSM Provider Reference Manual
January 2023 — Read these articles and more...
- Prior Authorization Codes Updated, Effective January 1
- Current Procedural Terminology (CPT®) Codes Updated for Prior Authorization for Medicare programs
- Cervical and Breast Cancer Screenings
- Clinical Payment and Coding Policy Updates
- Patients in the Qualified Medicare Beneficiary Program Should Not Be Billed
- Hospitals Must Provide Medicare Outpatient Observation Notice
- Centennial Care Behavioral Health Screening Incentive Program
- Blue Cross Community Centennial Members Rate Their Experience
- Our Blue Cross Community Centennial Quality Improvement Program
— Read this article and more...