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Blue Review — Provider Newsletter

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.

 

November 2018 Learn more about third-party links — Read these articles and more...

  • Importance of Adult Body Mass Index Measurement and Management
  • BCBSNM Preauthorization Changes Beginning Jan. 1, 2019
  • Specialty Pharmacy Infusion Site of Care: Preauthorization 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 Preauthorization 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 Learn more about third-party links — 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 Learn more about third-party links — 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 Preauthorization
  • 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 Learn more about third-party links — 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 Learn more about third-party links — 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 Learn more about third-party links — 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 Preauthorization
  • 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 Learn more about third-party links — 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 Learn more about third-party links — 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 Learn more about third-party links — 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 Learn more about third-party links — Read these articles and more...

  • AvailityTM 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 Learn more about third-party links — 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

December 2017 Learn more about third-party links — 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 CentennialSM 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 AdvantageSM 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 Learn more about third-party links — 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 AvailityTM 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 Learn more about third-party links — 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 Learn more about third-party links — 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 Learn more about third-party links — Read these articles and more...

  • BCBSNM Website
  • Receipt of Credentialing Application Notification
  • ClaimsXtenTM 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 Learn more about third-party links — Read these articles and more...

  • BCBSNM Website
  • ClaimsXtenTM 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 AvailityTM
  • 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 Learn more about third-party links — Read these articles and more...

  • BCBSNM Website
  • ClaimsXtenTM 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 AvailityTM
  • 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 Learn more about third-party links — Read these articles and more...

  • BCBSNM Website
  • ClaimsXtenTM Quarterly Updates
  • ClaimsXtenTM 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 AvailityTM
  • 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 Learn more about third-party links — Read these articles and more...

  • BCBSNM Website
  • ClaimsXtenTM 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 Learn more about third-party links — Read these articles and more...

  • ClaimsXtenTM Quarterly Updates
  • Kicking the Habit: Helping to Overcome Opioid Addiction in America
  • How are You Diagnosing Hypertension
  • AvailityTM 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 Learn more about third-party links — 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 Learn more about third-party links — Read these articles and more...

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

To request a PDF version of the Blue Review newsletter, call Network Services at 800-567-8540 or 505-837-8800.