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For Providers
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August 2024 |
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NEWS & UPDATES |
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Reminder
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EDUCATION & REFERENCE |
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Required Annual Cultural Competency Training Available Virtually
The training provides an overview of New Mexico’s diverse population to support access to care.
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NETWORK PARTICIPATION |
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Has Your Information Changed? Update Us and NPI Registry
When your practice address, phone number or other demographic information changes, update the National Provider Identifier Registry and us. Learn how to keep your information current.
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CODING AND CLAIMS |
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Proper Billing for Supplies for Transcutaneous Electrical Nerve Stimulation Units
Proper coding for TENS Units and necessary supplies eliminates additional costs to you and our members.
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Prior Authorization Updates for Commercial Members Effective Oct. 1
We’re changing prior authorization requirements that may apply for some commercial members to reflect new, replaced or removed codes.
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Check Prior Authorization Requirements for Procedure Codes through Availity® Essentials or Our IVR System
Our IVR phone system has a new menu option to quickly confirm prior authorization requirements for procedure codes for our commercial members. Learn how Availity and our IVR system can help save you time.
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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:
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CPCP006: Preventive Services Policy — Effective 07/01/24 |
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CPCP012: Hernia Repair — Effective 07/16/24 |
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CPCP021: Laboratory Panel Billing Guideline — Effective 07/16/24 |
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CPCP028: Non‑Reimbursable Experimental, Investigational and /or Unproven Services — Effective 07/01/24 |
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CPCP028: Non‑Reimbursable Experimental, Investigational and /or Unproven Services — Effective 10/01/24 |
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CPCP034: Unbundling Policy‑Professional Providers — Effective 06/25/24 |
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CPCP039: Outpatient Facility Service(s) Overlapping During an Inpatient Stay — Effective 07/16/24 |
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CPCP041: Sepsis Policy — Effective 07/16/24 |
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CLINICAL RESOURCES |
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Breast Cancer Screening for Members Ages 40 to 74
In line with new U.S. Preventive Services Task Force recommendations, we recommend that breast cancer screening for our members begin at age 40 rather than 50.
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Provider Finder® to Rank Providers to Help PPO Members Find Care
Later this year, Provider Finder will add a tiering feature that shows how providers rank against peers in their working specialties in some PPO products. Learn about the three tiers and how they help our members find care.
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BLUE CROSS MEDICARE ADVANTAGESM |
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Prior Authorization Updates for Medicare Advantage Effective Oct. 1
We’re changing prior authorization requirements that may apply for some Medicare members to reflect new, replaced or removed codes.
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Medicare Providers May Treat Blue Cross Group Medicare Advantage Open Access (PPO)SM Members
If you’re a Medicare provider, you may treat Blue Cross Group Medicare Advantage Open Access (PPO) members. This is an open access, non-differential national PPO plan without network restrictions.
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TURQUOISE CARE |
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Supporting EPSDT Compliance in School-Based Health Centers
We’re offering enhanced reimbursement payments to School-Based Health Centers for Early and Periodic Screening, Diagnostic and Treatment screenings and visits. These services ensure children enrolled in Medicaid receive timely and appropriate health care, which can lead to early detection and treatment of health issues.
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BLUE CROSS AND BLUE SHIELD OF NEW MEXICO IN THE COMMUNITY |
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BCBSNM Awards Grants to 25 Nonprofits Statewide
BCBSNM awarded 25 nonprofits with more than $860,000 in grants through our Blue ImpactSM Grant program. |
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Not Yet Contracted?
Providers who are participating in commercial products of BCBSNM are not automatically participating providers in Turquoise Care. If you are interested in becoming a provider of Turquoise Care, please call 505‑837‑8800 or 800‑567‑8540.
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Reminder: Update your Enrollment Information
Due to Turquoise Care requirements, all enrollment information (changes to demographics, licensure or certification, provider status, etc.) must be updated on the NM Medicaid Provider Web Portal  .
Visit our 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.
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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 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 handles all provider inquiries about claims status, eligibility, benefits and claims processing for members of BCBSNM. To contact the PSU for BlueCard® within BCBSNM, call 800‑222‑7992. For out‑of‑area claims inquiries, call 888‑349‑3706.
Network Services Contacts and Related Service Areas
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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
Policies at BCBSNM 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.
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Availity is a trademark of Availity, L.L.C., a separate company that operates a health information network to provide electronic information exchange services to medical professionals. Availity provides administrative services to BCBSNM.
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Blue Cross and Blue Shield of New Mexico, a Division of Health Care Service Corporation,
a Mutual Legal Reserve Company, an Independent Licensee of the Blue Cross and Blue Shield Association
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5701 Balloon Fiesta Pkwy NE, Albuquerque, NM 87113
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