March 2023

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 Blue ApprovR^SM Expedites Some Prior Authorizations — Attend a Training to Learn More

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

Updates made to the Provider Reference Manual

The BCBSNM Provider Reference Manual  (PRM) has been updated as part of an annual review, effective April 1, 2023. Changes to the PRM include, but are not limited to, the following sections:

The updated PRM is available on the Provider Reference Manual webpage. BCBSNM reminds providers to review the PRM for all changes.

Earn Continuing Education Credit through Webinar on Bipolar Disorder

Join us for a webinar, Bipolar Disorder: Diagnosis and Treatment, on Feb. 27 and March 1.

Cultural Awareness Webinars: Earn Continuing Education Credit

BCBSNM invites you to sign up for courses and earn continuing education credit. We’re pleased to offer these webinars at no cost through Quality Interactions, a separate company that provides cultural awareness training to health care professionals.

Verify Your Directory Details Every 90 Days

As a reminder, the Consolidated Appropriations Act (CAA) of 2021 requires that certain directory information be verified every 90 days. It must be verified every 90 days even if your data hasn’t changed since you last verified it.

Provider Onboarding Form Requirement

Effective March 1, 2023, BCBSNM will begin implementing a new requirement for all provider onboarding applications: all required fields in onboarding applications and related forms must be filled out completely or the document(s) will be rejected.

Closing Gaps in Colon Care

Preventive screenings are the most effective way to reduce the risk of colorectal cancer, according to the Centers for Disease Control and Prevention (CDC). The CDC and the U.S. Preventive Services Task Force recommend that everyone 45 to 75 years old get a screening.

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:

Quality Care: Screening for Depression

Screening patients for depression is an important part of outpatient visits. We created a video about depression screening tools, procedure codes and following up on positive screening.

Pharmacy Program Updates: Quarterly Pharmacy Changes Effective April 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 April 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 from BCBSNM or our vendor, Change Healthcare, as part of the Blue Cross and Blue Shield (BCBS) National Coordination of Care program. Please respond quickly to our requests, including requests related to risk adjustment gaps and Healthcare Effectiveness Data and Information Set (HEDIS^®) measures. Learn More.

In addition, you may receive requests from EXL Health for select inpatient, diagnosis-related claims. Learn more.

Survey to Assess Medicare Advantage Members’ Experiences

Every year some of our members receive a survey to collect information about their experiences with their health care providers, their Blue Cross Medicare Advantage plans and their prescription drug plans. The survey is sent to a random sample of our members from March through June and members are asked to rate their last six months of care.

Updates Made to the Blue Cross Medicare Advantage Provider Reference Manual

The Blue Cross Medicare Advantage Provider Reference Manual  (PRM) has been updated, effective April 1, 2023. Changes to the PRM include, but are not limited to, the following section:

The updated PRM is available on the Provider Reference Manual webpage. BCBSNM reminds providers to review the PRM for all changes.

COVID-19 Public Health Emergency Ending

During the COVID-19 public health emergency (PHE), the state was required to provide continuous Medicaid coverage without active renewal or eligibility determination. New federal laws have eliminated continuous enrollment requirements, and all New Mexicans covered by Medicaid will have to renew their Medicaid applications when they are notified by the Human Services Department.

New Mexico Human Services Department Issues Supplement #22-12 “Suspension of Prior Authorization Requirements for Skilled Nursing, Long-Term Care, and Home Health Facilities/Agencies”

The New Mexico Human Services Department (HSD) has issued Supplement #22-12 effective December 9, 2022. This supplement temporarily suspends prior authorization requirements related to the discharge and transfer of members from an acute care facility (ACF) to a skilled nursing, long-term care or home health facility/agency.

This supplement is related to the Public Health Emergency Order that was declared on December 5, 2022, because of the increased cases of RSV, Influenza-Like Illness and COVID-19 that then impacted ACFs.

View the full supplement on HSD’s website  .

Updates Made to the Blue Cross Community Centennial Provider Reference Manual

The Blue Cross Community Centennial Provider Reference Manual  (PRM) has been updated, effective April 1, 2023. Changes to the PRM include, but are not limited to, the following section:

The updated PRM is available on the Provider Reference Manual webpage. BCBSNM reminds providers to review the PRM for all changes.

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.