November 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 to Begin Jan. 1, 2023

Effective Jan. 1, 2023, BCBSNM will implement its new program with Avalon for claims for certain outpatient laboratory services provided to many of our commercial and BlueCard^® (out of area) members.

Postponed: Use Our Automated Phone System to Request Prior Authorization for FEP^® Members

BCBSNM has postponed the launch of a new feature to offer prior authorization for Federal Employee Program^® (FEP) members through our interactive voice response (IVR) system.

Watch News and Updates for future program announcements.

Confirm Medical Record Receipt Status Online for Prior Authorization Requests

You can now use the Medical Record Status Viewer to confirm receipt of medical records submitted by fax or mail to BCBSNM for prior authorization requests.

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.

Current Procedural Terminology (CPT^®) Codes Updated for Prior Authorization for Medicare programs

As of Jan. 1, we’re changing prior authorization requirements that may apply for some Medicare members to reflect new, replaced or removed codes.

Pharmacy Program Updates: Quarterly Pharmacy Changes Effective Oct. 1, 2022 — Part 2

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 Oct. 1, 2022

What You Need to Know About the Flu Season

The Centers for Disease Control and Prevention (CDC) recommends yearly flu vaccines for patients 6 months and older without vaccine contraindication. Providers may administer any U.S. Food and Drug Administration (FDA) approved, age‑appropriate flu vaccine.

Diabetes Screening for People Using Antipsychotic Medications

People with serious mental illness who use antipsychotic medications are at increased risk of diabetes, according to the National Committee for Quality Assurance (NCQA). Regular screening for diabetes is important for detecting, monitoring and in the treatment of the disease.

Submitting Unlisted or Miscellaneous Codes: Billing Guidelines and Reminders

When billing with unlisted or miscellaneous codes on claims submitted to BCBSNM, you can avoid additional documentation requests for unlisted or miscellaneous codes by describing the specific drug, service, supply or procedure provided.

Not Yet Contracted?

Providers who are participating in commercial BCBSNM products are not automatically participating providers in Blue Cross Community Centennial. 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.