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For Providers
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March 2024 |
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NEWS & UPDATES |
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COVID-19 Information for Providers
Please check the following Blue Cross and Blue Shield of New Mexico resources frequently for updates to important information related to COVID-19.
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Reminder: Update Your Records with New Mailing Addresses for Paper Claims
We announced new mailing addresses last September for faster claims processing and responses. If you haven’t yet updated your records, make note of the new addresses.
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Updates made to the Provider Reference Manual
The BCBSNM Provider Reference Manual has been updated, effective March 30, 2024. 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.
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NETWORK PARTICIPATION |
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Reminder
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CODING AND CLAIMS |
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Federal Employee Program Updates to Prior Approval Requirements and Benefits
As of Jan. 1, 2024, some changes are in effect for FEP® policy types.
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CLINICAL RESOURCES |
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Closing Gaps in Colon Care
Adults ages 45 to 75 should have preventive screenings to reduce their risk of colorectal cancer, according to the U.S. Preventive Services Task Force. We encourage you to discuss colon health and screening options with our members.
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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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CPCP009: Co-Surgeon/Team Surgeon Policy – Professional Provider — Effective 01/22/24 |
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CPCP013: Increased Procedural Services (Modifier 22) — Effective 01/22/24 |
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CPCP014: Global Surgical Package — Effective 01/22/24 |
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CPCP015: Multiple Surgical Procedures - Professional Provider Services — Effective 01/22/24 |
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CPCP016: Chiropractic Services — Effective 01/22/24 |
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CPCP023: Modifier Reference Policy — Effective 01/22/24 |
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CPCP028: Non-Reimbursable Experimental, Investigational and /or Unproven Services (EIU) — Effective 05/15/24 |
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CPCP040: Physical Medicine and Rehabilitation Services — Effective 01/22/24 |
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BEHAVIORAL HEALTH |
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Follow-up Care for Mental Health
Timely follow-up care after hospital visits for mental illness is linked to better health outcomes. You can help our members by encouraging follow-up care for mental health when appropriate.
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Avoiding the Inappropriate Use of Antipsychotic Medication in Anxiety Disorders
Most antipsychotic medications aren’t approved for the treatment of anxiety disorders and can have adverse effects. Read more about clinical practice guidelines and potential medication side effects.
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PHARMACY PROGRAM |
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Pharmacy Program Quarterly Update Changes Effective April 1, 2024 — 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, 2024 
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BLUE CROSS MEDICARE ADVANTAGESM (MEDICARE) |
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Medicare Advantage HEDIS Records Collection through June 2024
Medicare Advantage providers may receive requests from BCBSNM or our vendor Advantmed from January through June 2024 to collect data for HEDIS measures. |
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BLUE CROSS COMMUNITY CENTENNIALSM (MEDICAID) |
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Updates Made to the Blue Cross Medicare Advantage Provider Reference Manual
The Blue Cross Medicare Advantage Provider Reference Manual has been updated, effective April 1, 2024. Changes to the PRM include, but are not limited to, the following sections:
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Appeals and Grievance Contacts |
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Pharmacy Appeals Contact (Effective 4/1/24) |
The updated PRM is available on the Provider Reference Manual webpage. BCBSNM reminds providers to review the PRM for all changes.
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Blue Cross Community Centennial Members Rate Their Experience
BCBSNM surveys its members on an annual basis about their experience with their providers and the health plan.
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Blue Cross Community Centennial Quality Improvement Program
The BCBSNM Quality Improvement Program’s primary goal is to improve our members’ health status and outcomes by deploying meaningful quality improvement activities and interventions. These efforts are implemented across all care settings with the aim of improving the quality of care and services delivered to our members, your patients.
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Reminder
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BCBSNM IN THE COMMUNITY |
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New Mexico Medicaid Team Provides Prenatal Outreach to High-Risk Mothers
BCBSNM has a team of medical management specialists and care coordinators that work to fill care gaps and lower preterm births by identifying and reaching out to Medicaid members at risk of having pregnancy complications. |
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BCBSNM Provider Engagement
From left, Dr. Wendell Weston Sumner with Pediatric Health Services and Tricia MacLaughlin, Sr. BCBSNM Provider Relations Representative. MacLaughlin visited Dr. Weston Sumner for a provider visit on Jan. 30. Pictures displayed in the background were colored by Dr. Sumner’s patients. |
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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.
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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.
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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 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
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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
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.
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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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