December 2022

COVID‑19 Information for Providers

Please check the following Blue Cross and Blue Shield of New Mexico (BCBSNM) resources frequently for updates to important information related to COVID‑19:

New Laboratory Management Program Training Sessions

BCBSNM will be implementing our new Laboratory Benefit Management program with Avalon Health Solutions (Avalon) on Jan. 1, 2023. We’ll be offering training session on how to use this program.

2022 Annual HEDIS^® Medical Record Review Begins February 2023

BCBSNM collects healthcare effectiveness data annually through medical record chart review for reporting to the National Committee for Quality Assurance (NCQA^®) and the U.S. Department of Health and Human Services for the Quality Rating System for services provided in the previous calendar year (2022).

Prior Authorization Codes Updated, Effective January 1

As of Jan. 1, we’re changing prior authorization requirements that may apply for some commercial and Blue Cross Community Centennial^SM members to reflect new, replaced or removed Codes.

Continuity of Care is Driven by Prompt Communication Upon Hospital Discharge

Discharge summaries are critical to primary care providers (PCPs) as a key source of reference about the most up to date care their patients receive following their inpatient hospital stays. The hospital discharge summary is the key source for this information to support the continuity of care for all members.

Importance of Early and Timely Intervention for Pre- and Post‑Partum Care to Help Improve Health Outcomes

Federal Employee Program^® (FEP^®) members should be encouraged to establish early appointments for prenatal care. Providers should be notified immediately at time of discharge to facilitate the timely scheduling of post‑partum exams. This ensures continuity of care and to inform the member of next steps.

Keeping an Eye on Improved Provider Collaboration

Many PCPs refer our diabetic FEP members to eye care specialists for annual eye examinations. We want to encourage communication between members’ PCPs and eye care specialists for collaborating and supporting their ongoing health and wellness.

Statin Therapy for Patients with Cardiovascular Disease and Diabetes

Cardiovascular disease is the leading global cause of death, according to the World Health Organization. It accounts for 17.9 million deaths per year.

Clinical Payment and Coding Policy Updates

The Clinical Payment and Coding Policies on our website describe payment rules and methodologies for CPT, HCPCS and ICD‑10 coding for claims submitted as covered services. This information is a resource for our payment policies. It is not intended to address all reimbursement‑related issues. We regularly add and modify clinical payment and coding policy positions as part of our ongoing policy review process.

The following policies were updated:

New Tool Improves Behavioral Health Prior Authorization — Attend a Training

BCBSNM is streamlining the prior authorization process to reduce your workload with the launch of BlueApprovR^SM. This new tool in Availity^® Essentials expedites approvals for some behavioral health services for many of our commercial members.

Pharmacy Program Updates: Quarterly Pharmacy Changes Effective Jan. 1, 2023 — Part 1

Based on the availability of new prescription medications and Prime’s National Pharmacy and Therapeutics Committee’s review of changes in the pharmaceuticals market, some additions or drugs moving to a lower out‑of‑pocket payment level, revisions (drugs still covered but moved to a higher out‑of‑pocket payment level) and/or exclusions (drugs no longer covered) were made to the BCBSNM drug lists. Your patient(s) may ask you about therapeutic or lower cost alternatives if their medication is affected by one of these changes.

View the Pharmacy Program Updates effective as of Jan. 1, 2023 

Help Close Gaps in Care for Group Medicare Advantage Members

If we need medical records for Blue Cross Group Medicare Advantage (PPO)^SM members, you will receive requests only from BCBSNM or our vendor, Change Healthcare. This is part of the Blue Cross and Blue Shield (BCBS) National Coordination of Care program so that you won’t receive requests from multiple BCBS plans or their vendors. Please respond quickly to our requests, including requests related to risk adjustment gaps and Healthcare Effectiveness Data and Information Set (HEDIS^®) measures.

RSVP for 2022 Annual Medicaid Provider Training Sessions

BCBSNM is offering virtual provider training sessions for Blue Cross Community Centennial^SM network behavioral health, long‑term care and physical health providers and groups this December.

Not Yet Contracted?

Providers who are participating in commercial BCBSNM products are not automatically participating providers in Blue Cross Community Centennial^SM. If you are interested in becoming a Blue Cross Community Centennial provider, please call 505‑837‑8800 or 800‑567‑8540.

Reminder: Update your Enrollment Information

Due to Centennial Care requirements, all enrollment information (changes to demographics, licensure or certification, provider status, etc.) must be updated on the NM Medicaid Provider Web Portal .

BCBSNM Website

It’s important for you to stay informed about news that could affect your practice. BCBSNM offers many ways to stay informed via our website, bcbsnm.com/provider, and our provider newsletter, Blue Review. Signing up is easy.

Medical Policy Updates

Approved new or revised medical policies and their effective dates are usually posted on our website the 1st and 15th of each month. These policies may impact your reimbursement and your patients’ benefits. These policies are located under the Standards & Requirements tab at bcbsnm.com/provider.

Clinical Payment and Coding Policies

BCBSNM has adopted additional clinical payment and coding policies. These policies are based on criteria developed by specialized professional societies, national guidelines (e.g. Milliman Care Guidelines (MCG) and the CMS Provider Reimbursement Manual and are not intended to provide billing or coding advice but to serve as a reference for facilities and providers. These policies are located under the Standards & Requirements tab at bcbsnm.com/provider.

Claims Inquiries

Our Provider Service Unit (PSU) handles all provider inquiries about claims status, eligibility, benefits and claims processing for BCBSNM members. For the BCBSNM BlueCard^® PSU, call 800‑222‑7992. For out‑of‑area claims inquiries, call 888‑349‑3706.

Network Services Contacts and Related Service Areas

Verify Your Directory Details & Look for Reminders

Your directory information must be verified every 90 days under a new federal law. It’s easy and quick to get it done for all health plans in Availity^® , or if you prefer, you can use our Demographic Change Form. If we haven’t received your verification, look for emails and postcards from us with the checkmark symbol . They’re a friendly reminder that it›s time to verify or update.

Member Rights and Responsibilities

BCBSNM policies help address the issues of members participating in decision making regarding their treatment; confidentiality of information; treatment of members with dignity, courtesy and a respect for privacy; and members’ responsibilities in the practitioner‑patient relationship and the health care delivery process.