Blue Review — Provider Newsletter

December 2021  — Read these articles and more...

• COVID-19 Information for Providers
• Catch Up on Vaccines for All Ages
• Information About the 2021 2022 Flu Season and Vaccination
• Single Sign On Access to AIM Specialty Health^® via Availity^®
• New Provider Designations and Services Forms for Provider Onboarding Applications
• Watch for a Letter on Fighting Fraud, Waste and Abuse
• Current Procedural Terminology (CPT^®) Codes Updated for Prior Authorization (Commercial/Retail and Medicaid)
• Current Procedural Terminology (CPT^®) Codes Updated for Prior Authorization (Medicare)
• Claim Editing Enhancements Coming Jan. 10, 2022
• Including Behavioral Health Diagnoses on Claims and Referring to Behavioral Health Providers
• View Withdrawn Claim Descriptions via the Availity Claim Status Tool
• Reminder: Medicaid Providers Can Receive Payment for Project ECHO Consultations
• Health Benefits of Collaborating with Eye Care Professionals
• Hospital Discharge Summaries Are Important to Empower Members and Inform Specialists and Primary Care Providers
• Reminder to Encourage Early and Timely Intervention for Pre- and Post-Partum Care Even Now
• Our Medicaid Quality Improvement Program
• CMS Required Training for Dual Special Needs Plans
• Required Cultural Competency Training Available Online

November 2021  — Read these articles and more...

• COVID-19 Information for Providers
• New Laboratory Policies Coming Jan. 1, 2022
• 2022 Telemedicine Services
• Pharmacy Program Updates: Quarterly Pharmacy Changes Effective Oct.1, 2021 — Part 2
• Delivering Quality Care: Avoiding Antibiotics for Acute Bronchitis
• Delivering Quality Care: Managing Diabetes
• BCBSNM Moves to Streamline Coordination of Benefits for Members with Secondary Coverage
• Introducing Electronic Clinical Claim Appeal Requests via Availity^® Provider Portal
• Initiation of Substance Use Disorder Provider Enhanced Payment Program — Blue Cross Community Centennial
• Provider Incentive Program for Weight Assessment and Counseling for Children and Adolescents — Blue Cross Community Centennial
• Surprise Billing Provisions of No Surprises Act
• Provider Directory Information Verification
• Continuity of Care Changes
• New Information on Member ID Cards
• Machine-Readable Files
• CMS Required Training for Dual Special Needs Plans
• Required Cultural Competency Training Available Online

October 2021  — Read these articles and more...

• COVID-19 Information for Providers
• Coverage Replacement for Smoking Cessation Product CHANTIX^® Due to Voluntary Recall
• Reminder: Use AIM for Prior Authorization — Coming for Pharmacy Medical Oncology
• Change to Some Primary and Secondary Claims Coordination
• Documentation and Coding: Coding Cancer and Cancer-Related Treatments
• Delivering Quality Care: Breast Cancer Screening
• Are You Using These Shared Decision-Making Aids?
• Reminder: Controlling High Blood Pressure
• ClaimsXten^TM Quarterly Update Reminder
• Earn CME/CEU Credit at Free Webinar on Comorbid Conditions
• CMS-Required Training for Dual-Special Needs Plans
• Enhanced Clinical Editing Processes Begin Jan. 1, 2022 for Blue Cross Community Centennial Claims
• In-Home Diabetes Monitoring Tests Coming to Select Blue Cross Community Centennial Members
• Required Cultural Competency Training Available Online

September 2021  — Read these articles and more...

• COVID-19 Information for Providers
• Current Procedural Terminology (CPT^®) Codes Updated for Prior Authorization
• Documentation and Coding: Obesity and Morbid Obesity
• Updates to Clinical Practice and Preventive Care Guidelines
• Pharmacy Program Updates: Quarterly Pharmacy Changes Effective Oct. 1, 2021 — Part 1
• Current Procedural Terminology (CPT^®) Codes Updated for Prior Authorization for Medicare Programs
• Availity^® Claim Status Response Enhancement for Medicare Advantage Claims
• CMS-Required Training for Dual-Special Needs Plans
• Required Cultural Competency Training Available Online
• Reminder: Update your Enrollment Information

August 2021  — Read these articles and more...

• COVID-19 Information for Providers
• Prior Authorization Update – Pharmacy Medical Oncology
• Behavioral Health Provider Access Standards
• Adhering to HPV and Shingles Vaccine Guidelines
• Delivering Quality Care: Antidepressant Medication Management
• Colorectal Cancer Screening for Members Age 45 to 75
• National Drug Code (NDC) Fee Schedule Changes Effective Sept. 1, 2021
• CMS-Required Training for Dual-Special Needs Plans
• Required Cultural Competency Training Available Online
• Reminder: Update your Enrollment Information

July 2021  — Read these articles and more...

• COVID-19 Information for Providers
• Coming Soon: View Professional Provider Fee Schedule via Availity^®
• Reminder: Current Procedural Terminology (CPT^®) Codes Updated for Prior Authorization
• Delivering Quality Care: Supporting Mental Health
• Catch Up Now on Child and Adolescent Vaccinations
• Earn CME/CEU Credit at Free Webinar on Opioid Use
• In Home Test Kits for Colorectal Cancer Screening
• Pharmacy Program Updates: Quarterly Pharmacy Changes Effective July 1, 2021 — Part 2
• Delivering Quality Care: Treating Substance Abuse
• Provider Access and Availability Survey
• Closing Gaps in Care for Group Medicare Advantage (MA) Members
• Reminder: Current Procedural Terminology (CPT^®) Codes Updated for Prior Authorization for Blue Cross Medicare Advantage^SM and Blue Cross Community Centennial^SM Medicaid programs
• CMS-Required Training for Dual-Special Needs Plans
• Required Cultural Competency Training Available Online
• Reminder: Update your Enrollment Information

June 2021  — Read these articles and more...

• COVID-19 Information for Providers
• ClaimsXten^TM Quarterly Update Reminder
• Current Procedural Terminology (CPT^®) Codes Updated for Prior Authorization
• Pharmacy Program Updates: Quarterly Pharmacy Changes Effective July 1, 2021 — Part 1
• BCBSNM Members Have New Mail Order and Specialty Pharmacies as of May 1, 2021
• National Drug Code (NDC) Fee Schedule Change for Octagam (J1568)
• Prepayment Reviews on Inpatient DRG Claims for BlueCard Members
• EXL Health to Review Complex Claims July 1, 2021
• Delivering Quality Care: Treating Substance Abuse
• Current Procedural Terminology (CPT^®) Codes Updated for Prior Authorization for Blue Cross Medicare Advantage^SM and Blue Cross Community Centennial^SM Medicaid programs
• CMS-Required Training for Dual-Special Needs Plans
• Required Cultural Competency Training Available Online
• Reminder: Update your Enrollment Information

May 2021  — Read these articles and more...

• COVID-19 Information for Providers
• Some Codes Removed from AIM^® Prior Authorization
• Select Medication List to be Updated June 1, 2021
• Pharmacy Program Updates: Quarterly Pharmacy Changes Effective April 1, 2021 — Part 2
• Documentation and Coding: Major Depressive Disorder
• Delivering Quality Care: Cervical Cancer Screening May Save a Life
• Delivering Quality Care: Caring for the Colon
• Provider Satisfaction Survey 2021
• New Applied Behavior Analysis (ABA) Service Request Forms
• CMS-Required Training for Dual-Special Needs Plans
• Required Cultural Competency Training Available Online
• Reminder: Update your Enrollment Information

April 2021  — Read these articles and more...

• COVID-19 Information for Providers
• Single Access Point for EFT and ERA Enrollments
• Telehealth Place of Service Code Enabled
• Health Care Quality: Blood Pressure Control – Speaking Out About the 'Silent Killer'
• The CAHPS^® Survey: We All Play a Role
• Updates Made to the Provider Reference Manual
• CMS-Required Training for Dual-Special Needs Plans
• Required Cultural Competency Training Available Online
• Reminder: Update your Enrollment Information

March 2021  — Read these articles and more...

• COVID-19 Information for Providers
• BCBSNM will update CPT^® Codes for some outpatient services, added benefits with AIM Specialty Health^® (AIM) Effective April 1, 2021
• CPT Category II Codes Can Help Close Care Gaps
• Overpayment Recovery for Multiple Surgical Procedures
• Pharmacy Program Updates: Quarterly Pharmacy Changes Effective April 1, 2021, Part 1
• CMS-Required Training for Dual-Special Needs Plans
• Updates made to the Blue Cross Community Centennial Section of the BCBSNM Provider Reference Manual
• Required Cultural Competency Training Available Online
• Reminder: Update your Enrollment Information

February 2021 — Read these articles and more...

• COVID-19 Information for Providers
• Documenting and Coding Guidance for Atrial Fibrillation
• Documenting and Coding Guidance for Diabetes Mellitus
• BCBSNM Federal Employee Program^® Annual Medical Record Data Collection for Quality Reporting — HEDIS Measurement Year (MY) 2020 Begins Feb. 1, 2021
• New HEDIS^® Tip Sheets^* Behavioral Health HEDIS Measures: FUA and FUM
• Outpatient Provider Incentive Program for Behavioral Health Follow-up Visit
• Childhood Immunization Rates Fall Amidst Pandemic Fears
• Clinical Practice and Preventive Care Guidelines Updated for 2020-2021
• Pharmacy Program Updates: Quarterly Pharmacy Changes Effective Jan.1, 2021 — Part 2
• Coverage for Contraception Act
• CMS-Required Training for Dual-Special Needs Plans
• Required Cultural Competency Training Available Online
• Reminder: Update your Enrollment Information

January 2021 — Read these articles and more...

• COVID-19 Information for Providers
• Providers receiving bamlanivimab for free should not bill for the product
• Reminder: Transition of Care: Preauthorization Changes from eviCore to AIM Specialty Health^® (AIM) for Some Members effective Jan. 1, 2021
• Reminder: Use the AIM ProviderPortal for Pre & Post Service Reviews
• Annual HEDIS^® Medical Record Review for Measurement Year 2020 to begin February 2021
• BCBSNM will update CPT^® codes for some outpatient services, added benefits with AIM
• Quality Health Standards — Prenatal and Postpartum Visits
• Medicare adds benefit for members with inherited ovarian or breast cancer
• Hospitals Must Provide Medicare Outpatient Observation Notice (MOON)
• Obtain BCBSNM Patient ID Numbers Online via Availity^® — Now Available for Government Programs
• Patients in the Qualified Medicare Beneficiary (QMB) Program Should Not Be Billed
• Blue Cross Medicare Advantage Dual Care (HMO SNP) 2019 Program Summary
• CMS Required Training for Dual Special Needs Plans
• Coverage for Coronary Artery Calcium Scan for Cardiovascular Disease Risk Assessment
• Required Cultural Competency Training Available Online

December 2020 — Read these articles and more...

• COVID-19 Information for Providers
• BCBSNM Moving Preauthorization Duties from eviCore to AIM Effective Jan. 1, 2021, for Some Members
• BCBSNM Preauthorization Changes Beginning Jan. 1, 2021
• Revision to Specialty Medication Administration Site of Care Policy, Effective Jan. 1, 2021
• Availity Claim Status Tool Now Available for All BCBSNM Members
• Updates Made to the Provider Reference Manual
• Billing Reminders for Psychological and Neuropsychological Testing
• New HEDIS^® Tip Sheets for Behavioral Health HEDIS Measures: APM and UOP
• New Electronic Duplicate Claim Rejections for Commercial Claims Effective Nov. 14, 2020
• Verify Multiple Patient's Eligibility and Benefits Coverage via Availity^®
• View, Download and Print the BCBSNM Member's ID Card Online via the Availity Provider Portal
• Are Utilization Management Decisions Financially Influenced?
• Pharmacy Program Updates: Quarterly Pharmacy Changes Effective Oct. 1, 2021, Part 1
• Health Benefits of Collaborating with Eye Care Professionals
• Importance of Hospital Discharge Summaries Both Empowers the Members and Informs Primary Care Providers
• 2020 Reminder to Encourage Regular Pre- and Post-Natal Care
• 2021 Blue Cross Medicare Advantage Preauthorization Updates
• CMS-Required Training for Dual-Special Needs Plans
• 2021 Blue Cross Community Centennial Prior Authorization Updates
• Our Medicaid Quality Improvement Program
• Required Cultural Competency Training Available Online

November 2020 — Read these articles and more...

• COVID-19 Information for Providers
• Clinical Practice Guidelines for the Metabolic Syndrome and Management of Overweight and Obesity in Adults
• Submit Electronic Professional and Facility Claims via the Availity^® Provider Portal
• Availity Provider Portal Offerings
• Availity Claim Status Tool Now Available for All BCBSNM Members
• Updates and Reminders: Submit Predetermination of Benefits Submission via Availity
• Telemedicine — Future State
• Are You Using These Shared Decision‑Making Aids?
• BCBSNM Names New President
• Provider Finder^® Gets an Upgrade
• CMS-Required Training for Dual-Special Needs Plans
• Preparing for the 2020-2021 Flu Season: Administering Flu Vaccines During the COVID‑19 Pandemic
• Required Cultural Competency Training Available Online

October 2020 — Read these articles and more...

• COVID-19 Information for Providers
• In-Home Test Kits for Diabetics
• Share Your Medication Assisted Treatment Designation
• Blue Distinction^® Message via the Availity^® Eligibility and Benefits Results
• Verify Procedure Code Preauthorization Requirements and Submit the Request via Availity
• Outpatient Provider Incentive Program for Behavioral Health Follow‑up Visit
• Pharmacy Program Updates: Quarterly Pharmacy Changes Effective Oct. 1, 2020, Part 2
• Provider Finder^® Gets an Upgrade
• CMS-Required Training for Dual-Special Needs Plans
• In-Home Diabetes Monitoring Tests Coming to Select Blue Cross Community Centennial^SM Members
• Required Cultural Competency Training Available Online

September 2020 — Read these articles and more...

• COVID-19 Information for Providers
• Reminder for Billing Point-of-Use Convenience Kits
• Submit Predertermination of Benefits Requests via Availity
• iExchange Deactivated on Aug. 17, 2020
• Two New Behavioral Health Measures Tip Sheets
• Outpatient Provider Incentive Program for Behavioral Health Follow-up Visit
• NMSU, BCBSNM Partner to row Health Care Workforce
• Pharmacy Program Updates: Quarterly Pharmacy Changes Effective Oct. 1, 2020, Part 1
• BCBSNM Medical Policies
• Imaging Studies for Low Back Pain for FEP Members
• CMS-Required Training for Dual-Special Needs Plans
• Threshold Amount for Claims Review for Blue Cross Community Centennial Members
• Required Cultural Competency Training Available Online

August 2020 — Read these articles and more...

• COVID-19 Information for Providers
• Federal Agencies Extend Timely Filing and Appeals Deadlines
• Colorectal Cancer Screening at Home
• Overpayment Recovery Process for Contracted Providers – Changes as of Jan. 1, 2020
• COVID-19 Coverage Updates for Medicare Providers
• CMS Payment Adjustments for Medicare Providers
• Blue Cross Medicare Advantage Prior Authorization Updates effective Sept. 1, 2020
• Addition of New Prior Authorization Requirements for Blue Cross Community CentennialSM Members
• CMS-Required Training for Dual–Special Needs Plans
• Required Cultural Competency Training Available Online

July 2020 — Read these articles and more...

• COVID-19 Information for Providers
• BCBSNM will update CPT Codes for some preauthorization Services
• Are you submitting claims correctly for medications that come in additional packaging?
• Pharmacy Program Updates: Quarterly Pharmacy Changes Effective July 1, 2020 – Part 2
• New Email Address for Prior Authorization Appeals Effective July 1, 2020
• CMS-Required Training for Dual–Special Needs Plans
• Required Cultural Competency Training Available Online

June 2020 — Read these articles and more...

• COVID-19 Information for Providers
• Blue Cross and Blue Shield of New Mexico Contributes $1 million To Aid New Mexico's COVID-19 Response
• Learn how to Submit a Prior Authorization through the eviCore Web Portal
• Calls to Electronic Commerce Services will be Redirect to Email as of June 15, 2020
• CMS-Required Training for Dual-Special Needs Plans
• Required Cultural Competency Training Available Online

May 2020 — Read these articles and more...

• COVID-19 Information for Providers
• Obtain your Provider Claim Summary (PCS) Online — PCS Mailing Discontinuation as of May 4, 2020
• Remember to use In-Network Laboratories
• Stand Up and Be Counted
• CMS-Required Training for Dual-Special Needs Plans
• New Annual Wellness Visit Resources for Medicare Providers
• Required Cultural Competency Training Available Online

COVID-19 Special Edition Blue Review - A digest of information for providers

April 2020 — Read these articles and more...

• Three New ClaimsXtenTM Rules to be Implemented June 2020
• Obtain Your Provider Claim Summary (PCS) Online — PCS Mailing Discontinuation as of May 4, 2020
• Pharmacy Program Updates: Quarterly Pharmacy Changes Effective April 1, 2020, Part 1
• CMS-Required Training for Dual-Special Needs Plans
• CMS Star Ratings Matter: Survey to Assess Medicare Advantage Members’ Experiences
• Required Cultural Competency Training Available Online
• Telemedicine Grant Funding Opportunity for Contracted Providers
• 2020 Centennial Care Performance Measures
• Updates Made to the Blue Cross Community Centennial Section of the BCBSNM Provider Reference Manual

February/March 2020 — Read these articles and more...

• Two New ClaimsXten^TM Rules to be Implemented in 2020
• New BCBSNM 837 Commercial Claim Validation Edits
• Prior Authorization Changes for ID Prefixes BBE, BHP, BNK, BRG and BYR
• Shared Decision Making Aids Available Online
• Introducing a New Preauthorization Submission Tool via Availity^® Provider Portal
• 2020 Annual HEDIS^® Medical Record Review Begins February 2020
• CMS Required Training for Dual Special Needs Plans
• Thank You: RADV/IVA Project 2019
• Updates Made to the Medicare Advantage Section of the Provider Reference Manual
• Required Cultural Competency Training Available Online
• 2019 Medical Record Review
• Pregnant Women and Vaccines

January 2020 — Read these articles and more...

• Two New ClaimsXten^TM Rules to be Implemented in 2020
• New HEDIS^® Behavioral Health Measures Tip Sheets
• Reminder that Laboratory Benefit Level Changes for Some Members this Month
• CMS-Required Training for Dual-Special Needs Plans
• Reminder: Medicare Providers May Not Bill Participants in the Qualified Medicare Beneficiary Program
• Medicare Advantage 30-Day Facility Readmissions Review
• National Coordination of Care^SM Program to Serve Group Blue Cross Medicare Advantage (PPO)^SM Members
• Annual Reminder: Medicare Outpatient Observation Notice Required
• Updates Made to the Medicare Advantage Section of the Blues Provider Reference Manual
• Required Cultural Competency Training Available Online
• Changes to the HEDIS 2020 Prenatal and Postpartum Care Measure
• Survey Shows Medicaid Members Give Their Providers High Ratings
• Our Medicaid Quality Improvement Program

December 2019 — Read these articles and more...

• Coordinating Care Between Behavioral Health and Medical Providers
• Referring Members to In-Network Laboratories
• Availity^® Remittance Viewer Tool Upgrade
• New Online Enrollment Process for 835 EFT & ERA through the Availity Provider Portal
• New Programs Help Members Lead Healthier Lives
• Pharmacy Program Updates: Quarterly Pharmacy Changes Effective January 1, 2020 – Part 2
• Recommendations and Reminders for Eye Care Professionals
• Information for Primary Care Providers – Importance of Hospital Discharge Summaries
• CMS Required Training for Dual Special Needs Plans
• 2019 Updates in Pre- and Post-Natal Care Information to Support Effective Coordination and Continuity of
• Reminder of Change to the Preservice Appeals Process for your Medicare Patients Covered by BCBSNM
• Medicare Advantage: Electronic Payment Summary Now Available for 835 ERA Receivers
• Tips for Providing Reimbursable Telemedicine Services to BCBSNM Members
• Blue Cross Community Centennial Quality Toolkit Updates

November 2019 — Read these articles and more...

• Antibiotic Use in Outpatient Settings
• Collaborating to Reduce Opioid Abuse
• Be Covered — Increasing Coverage for the Uninsured and Underinsured
• What You Need to Know About the 2019-2020 Flu Season
• Are Utilization Management Decisions Financially Influenced?
• Pharmacy Program Updates: Quarterly Pharmacy Changes Effective January 1, 2020 — Part 1
• NDC Fee Schedule Change for Fulphila (J5108) and Udenyca (J5111) Effective January 1, 2020
• Updates Made to the Provider Reference Manual
• CMS Required Training for Dual Special Needs Plans
• New Names and ID Cards for Group Medicare Plans
• 2020 Blue Cross Medicare Advantage Preauthorization Updates
• Billing and Documentation Guidelines for Urine Drug Tests
• 2020 Blue Cross Community Centennial Prior Authorization Updates

October 2019 — Read these articles and more...

• HHS-RADV/IVA – Frequently Asked Questions
• Addition of New Prior Authorization Requirements for New Mexico Members
• A Change in the Coding of Physical Medicine Service Units: Time Based Measurement Standard to Follow AMA
• Measure and Document Body Mass Index (BMI)
• BCBSNM to Review Implant Claims from Stand Alone ASCs
• Pharmacy Program Updates: Quarterly Pharmacy Changes Effective October 1, 2019 — Part 2
• Laboratory Benefit Level Change
• CMS Required Training for Dual Special Needs Plans
• Changes to Medicare Advantage Payment Models for Skilled Nursing Facility and Home Health Care Claims
• Medicare PTAN and Medicaid Numbers/Letters Required for Network Inclusion
• New Program Notification: Opioid Diagnosis Code Required at Pharmacy
• Screening for Clinical Depression Initiative
• Behavioral Health and Addiction TeleECHO Program

September 2019 — Read these articles and more...

• FEP Blue Focus Prior Authorization Reminder
• New Online Case and Credentialing Status Checkers
• New Addresses for Claims Overpayment Returns
• Respond Electronically to medical Record Requests for Quality and risk Adjustment, and soon Claims, via Availity Provider Portal
• Well–Child Visits Within the First 15 Months of Life (W15)
• New and Exciting Functionality Coming to the Claim Research Tool (CRT) via Availity Provider Portal
• IVR Phone System: Consolidated Benefit Response
• Medicare Advantage Updates to Provider Finder Coming in September 2019
• CMS–Required Training for Dual-Special Needs Plans

August 2019 — Read these articles and more...

• Pharmacy Program Updates: Quarterly Pharmacy Changes Effective July 1, 2019
• Reminder: Verify Procedure Code Preauthorization Requirements Online
• Member Letters Have a New, Simpler Look
• CMS Required Training for Dual-Special Needs Plans
• Notice of Change to Preservice Appeals Process for your Medicare Patients Covered by BCBSNM
• Blue Cross Community Centennial^SM Quality Toolkit Updates

July 2019 — Read these articles and more...

• Availity^® Claim Research Tool Offers Enhanced Claim Status Results
• Provider Signature Attestations for the HHS Risk Adjustment Data Validation Program
• A Call to Immunize New Mexico Children
• Changes to Behavioral Health Claim Review
• Out of State Electronic Remittance Advice (ERA) Enrollment Notification
• CMS Required Training for Dual-Special Needs Plans
• Removal of Prior Authorization Requirements for your Medicare Advantage Patients
• Automated Phone System Offers More Service Options for Medicare Advantage

June 2019 — Read these articles and more...

• Pharmacy Program Updates: Quarterly Pharmacy Changes Effective July 1, 2019
• In–home Colorectal Cancer Screening Test Provided to Select Members
• Screening and Treatment for Hepatitis C
• Thank You for Participating in the HEDIS Medical Records Project
• Helping Patients Shop for Cost-Effective Knee/Hip Replacements
• Changes to Specialty Drugs Preauthorization List: Always Check Preauthorization Requirements
• CMS–Required Training for Dual-Special Needs Plans
• Reporting On-Demand Application Now Available for Government Programs via Availity^® Provider Portal

May 2019  — Read these articles and more...

• BCBSNM is Continuing our Efforts to Validate Data for Our Provider Directories
• Living365^® "Living with Diabetes" Health Education Classes Available for All Blue Cross and Blue Shield of New Mexico Members
• Imaging Studies for Low Back Pain
• Making an Impact in Our Community
• Check Eligibility and Benefits: Don't Skip This Important First Step!
• May is Mental Health Month: Talk to Your Patients About Depression
• BCBSNM Now Offers a Choice in Pharmacies for Specialty Medications
• CMS-Required Training for Dual-Special Needs Plans

April 2019  — Read these articles and more...

• Changes to the Three-Character Prefix on Member ID Cards
• Check you Patients’ Behavioral Health Preauthorization Requirements
• Save Time by Using eviCore Web Portal for Preauthorization Requests
• Pharmacy Program Updates: Quarterly Pharmacy Changes Effective April 1, 2019
• Medical records Request Reminder
• Clinical Payment and Coding Policies
• CMS-Required Training for Dual-Special Needs Plans
• Change in Reject Notification for Invalid National Drug Codes (NDCs) Used on Electronic Medicare Advantage Claims

March 2019  — Read these articles and more...

• BCBSNM’s Payer Spaces Updates in Availity^® Provider Portal
• We Need Your Help to Improve Behavioral Health Care Access!
• Referring Members to In-Network Laboratories
• Clinical Payment and Coding Policies
• Importance of Adult Body Mass Index (BMI) Measurement and Management
• BCBSNM Will No Longer Accept Paper Onboarding Forms for Certain Provider Types Effective May 1, 2019
• Are You Using These Shared Decision-Making Aids?
• CMS-Required Training for Dual-Special Needs Plans
• Annual Reminder: Medicare Outpatient Observation Notice (MOON) Required Training for Dual-Special Needs Plans
• Government Programs: Verifying Claim Status in the Availity Provider Portal
• Change in Preferred Hepatitis C Agent for Blue Cross Community Centennial Members, Effective March 1, 2019
• 2019 HSD Behavioral Health Policy and Billing Manual and Supplement 19-04
• 2019 Blue Cross Community Centennial Prior Authorization Updates

February 2019  — Read these articles and more...

• Pharmacy Program updates: Quarterly Pharmacy Changes Effective Jan. 1, 2019
• We Need Your Help to Improve Behavioral Health Care Access!
• 2019 Standards of Medical Care in Diabetes
• Why Doctors Review Health Insurance Claims
• Clinical Payment and Coding Policies
• CMS–Required Training for Dual-Special Needs Plans
• 2018 Medical Record Review
• 2019 Blue Cross Community Centennial Prior Authorization Updates
• Reminder: GuidingCare^® is Now Available for New Mexico Medicaid Providers

January 2019  — Read these articles and more...

• Automated Phone system Change for Behavioral Health Services
• Close HEDIS^® Gaps Easily Through the Availity Provider Portal
• Behavioral Health Forms Get a Facelift
• 2019 Annual HEDIS medical Record Review Begins February 2019
• Notification of Annual Benefit Updates
• Clinical Payment and Coding Policies
• CMS-Required Training for Dual-Special Needs Plans
• New Opioid Drug Management Program for Medicare Members
• New Concurrent Opioid and Benzodiazepine Prior Authorization Program for Blue Cross Community Centennial Members

December 2018  — Read these articles and more...

• 2019 Benefit Preauthorization Changes: eviCore^® Training, Reminders and Resources
• Additional Clinical Payment and Coding Policies
• Responding to Electronic Quality and Risk Adjustment Medical Record Requests via Availity^TM Provider Portal
• Cardiology Services No Longer Require Preauthorization for Blue Cross Medicare Advantage, Effective Dec. 17, 2018
• Introducing FEP Blue Focus^SM
• Change in Preferred Diabetic Testing Supplies for Blue Cross Community Centennial^SM Members, Effective Jan. 1, 2019
• Performance Measure – Timeliness of Postpartum Care

November 2018  — Read these articles and more...

• Importance of Adult Body Mass Index Measurement and Management
• BCBSNM Preauthorization Changes Beginning Jan. 1, 2019
• Specialty Pharmacy Infusion Site of Care: Preauthorization Requirements
• 2019 Blue Cross Community Centennial Prior Authorization Updates
• Required Cultural Competency Training Available Online
• Proper Claim Filing Procedures for Blue Cross Community Centennial Behavioral Health Providers
• 2019 Blue Cross Medicare Advantage Preauthorization Updates
• Government Programs: Interpreting the ‘PLB’ Segment on the 835 Electronic Remittance Advice (ERA)
• CMS-Required training for Dual-Special Needs Plans
• FEP Benefits Changes for Infliximab Effective Jan. 1, 2019
• Documentation During Pregnancy
• Importance of Hospital Discharge Summaries
• Referring Diabetic Patients for Annual Eye Exams

October 2018  — Read these articles and more...

• Prepping for the 2018-2019 Flu Season
• New Application Process for Joining Out Networks
• ‘Annual Visit’ Campaign Continues, Proper Coding is Crucial
• Screening and Management for Clinical Depression
• Important Reminder: Rendering, Ordering, Attending and Referring Providers Must Enroll with NM Medicaid for Blue Cross Community Centennial Claims

September 2018  — Read these articles and more...

• Quarterly Pharmacy Updates Effective July 1, 2018
• Amniotic Membrane and Amniotic Fluid Products May Be Considered Experimental, Investigational and/or Unproven
• Working Together To Improve The Member-Provider Experience: Member Concerns About Genetic Testing Costs And Coverage
• New Lactation Consultation Designation Added To Demographic Change Form
• New Application Process For Joining Our Networks
• Important Reminder: Claims Will Deny If Rendering NPIs Are Not On File With BCBSNM
• Important Reminder: Inpatient Services Require Preauthorization
• Government Programs: Improving Claim-Related Processes and EDI Transactions
• Tips for Providing Reimbursable Telemedicine Services to Blue Cross Community Centennial members
• Important Reminder: Rendering, Ordering, Attending and Referring Providers Must Enroll with NM Medicaid for Blue Cross Community Centennial Claims

August 2018  — Read these articles and more...

• Appropriate Use of Opioids Program, Launched Aug. 1, 2018
• Voluntary Recall of medications Containing the Valsartan Active Ingredient
• Annual Visit Campaign Leads to Importance of Proper Coding
• Making the Health Care System Work better Together
• 2019 Blue Cross Centennial Care Contracts
• New Mexico Medicaid Fee Schedule for Behavioral Health Providers Effective July 1, 2018

July 2018  — Read these articles and more...

• High-Dose Influenza Vaccine Guidelines
• Working Together to Improve the Member-Provider experience: Member Concerns about “Up Front” Payments
• Making the Health Care System Work Better Together
• Annual Training for Medicaid Providers
• CMS0Required Training for Dual-Special Needs Plans
• Prohibition on Billing Dually Eligible Members Enrolled in the Qualified Beneficiary Program

June 2018  — Read these articles and more...

• Select Specialty Medications to Transition to Accredo Specialty Pharmacy
• Addressing What Matters: How BCBSNM is Tackling the Opioid Crisis
• V55 Claim Denial Resolution
• HCPCS Mammogram Code Replacement
• Reminder: Inpatient Services Require Preauthorization
• New eviCore Email Notification for Utilization Management Decisions
• Quickly, Efficiently Manage and Respond to Coding Opportunities Online Through the Availity Provider Portal
• Updates Made to Blue Cross Community Centennial Provider Reference Manual
• Nursing Facility Bed Hold Days
• Additional CLIA-Waived Codes

May 2018  — Read these articles and more...

• Quarterly Pharmacy Changes Effective Apr. 1, 2018
• Services Rendered by Providers to Related Members and/or Self
• Making the Health Care System Work Better Together
• Member Concerns About DME – Working Together to Improve the Member-Provider Experience
• Critical Incident Reporting
• 2018 Billing and Documentation Guidelines for Urine Drug Tests

April 2018  — Read these articles and more...

• Updated Forms Available on Provider Website
• Quickly Manage and Respond to Risk Gaps Through the Availity Web Portal
• BCBSNM Approves Coverage of new Shingles Vaccine: Shingrix
• Cancer Prevention: The Added Value in Adolescent Immunizations
• Working Together to Improve the Member-Provider Experience: Choosing the Best Direction
• Updated Online NDC Units Calculator Tool Now Available
• Fall Prevention: Resources for Providers and members
• Rendering, Ordering, Attending and Referring Provider Information Required for Blue Cross Community Centennial Claims
• CareLink New Mexico Integrates Physical and Behavioral Health Services

March 2018  — Read these articles and more...

• Interpreting the “PLB” Segment on the 835 ERA
• Making the Health Care System Work Better Together
• Quarterly Pharmacy Changes Effective Jan. 1, 2018
• March into Colon Cancer Awareness Month
• Behavioral Health: Let’s Talk About It!
• New Medicaid ID Numbers for Members

February 2018  — Read these articles and more...

• Availity^TM Claim Research Tool Offers Enhanced Claim Status Results
• Electronic Commerce Services – Hours of Operation Update
• BCBSNM Awarded Centennial Care 2.0 Contract
• Hypertension: Resources for Providers and Members
• Other Provider Resources

January 2018  — Read these articles and more...

• 2018 Holiday Schedule Reminders for 835 and 837 Transactions
• Notice of Annual Benefit Updates
• Pharmacy Benefit Tips
• Online Magazine Spotlight: How Health Care Veterans Foster (and Learn from) Startups
• Skilled Nursing Facility (SNF) Benefit Change for FEP Members

December 2017 — Read these articles and more...

• 2018 Additional Preauthorization Requirements
• "Pulling It All Together" - Colon Cancer Screenings Goal: 80% Participation by 2018
• Reimbursement Policy Update Effective Jan. 1, 2018
• Pharmacy Program Updates: Quarterly Pharmacy Changes Effective Oct. 1, 2017
• 2018 Blue Cross Community Centennial^SM Preauthorization Updates
• Service Spotlight: Special Beginnings^® Maternity Program
• Updated Diagnosis Related Group Rates
• New Dental Varnish Billing Code
• Survey Shows Medicaid members Give Their Providers high Ratings
• Looking Back at HEDIS^®: Results for HEDIS 2015, 2016 and 2017
• Our Medicaid Quality Improvement Program
• Electronic Visit Verification (EVV) Claim Entries Require Supporting Documentation
• 2018 Blue Cross Medicare Advantage^SM Preauthorization Updates
• In-Home FOBT/FIT & HbA1c test Kits for FEP Members
• 2018 FEP utilization Management Clinical Guideline 002: Inpatient Skilled Nursing Facility Care

November 2017 — Read these articles and more...

• 2018 HEDIS^® Medical Record Review Begins February 2018
• New medical Record Retrieval Vendor for Out-of-Area Blue Plan Member Records
• New Online Magazine Spotlights Emerging Episodes of Care Payment Model
• BCBSNM Celebrates LGBTQ Inclusion
• Important Information on ABA Forms, Authorizations and Payment
• Billing for Binaural Hearing Aids
• How to Find BCBSNM Resources in Availity^TM Payer Spaces
• Adhering to Vaccination Guidelines
• Make Your Focus Clear on Eye Care with Retinopathy Screening
• Important Notice Regarding Allergy Services
• Documentation Guidelines for Laboratory Audit/Review
• Operational Effectiveness: Better and Faster Ways to Do Business Together
• National Diabetes Month 2017
• Living 365SM Diabetes Education Classes
• Cold Weather Asthma: Prevention Through Education
• FEP Plan Update

October 2017 — Read these articles and more...

• Antidepressant Medication Management Initiative
• Flu Vaccines, Billing, and CPT Codes
• Examining Variability in Pricing Solutions Through Shared Data

September 2017 — Read these articles and more...

• BCBSNM Website
• Adult BMI Assessment
• Annual Well-Child Visit Important for Children and Caregivers
• Identifying and Prescribing Correct Glucose Meter Test Strips
• HSD No Longer Issuing Separate Medicaid Cards for MCO-Enrolled Members
• Blue Cross Medicare Advantage: Electronic Claim Submission Edits
• Government Programs: Claims Rejecting as Duplicate Submissions
• Prohibition on Billing Dually-Eligible Members Enrolled in the Qualified Medicare Beneficiary Program

August 2017 — Read these articles and more...

• BCBSNM Website
• Receipt of Credentialing Application Notification
• ClaimsXten^TM Quarterly Updates
• Code Auditing Enhancement
• New Claim Payment and Remittance Resources
• EFT and ERA Update for Non-Contracted Government Programs Providers
• Integration of Prime Therapeutics^® and Walgreens^® Specialty Pharmacy and Mail-Order Services
• Where Data Flows, Improvements are Bound to Follow
• Blue Cross Community Centennial Changes, Effective July 21, 2017
• Submitting Electronic Claims for Blue Cross Community Centennial Members
• Pharmacy Change for blue Cross Community Centennial Members Effective Sept. 1, 2017
• Antidepressant Medication Management Initiative

July 2017 — Read these articles and more...

• BCBSNM Website
• ClaimsXten^TM Announces Software Version Upgrade
• Utilization Management Determinations
• Insurers Required by CMS to Conduct ACA Risk Adjustment Program Audit
• Appointment Availability and Access Guidelines
• Receipt of Credentialing Application Notification
• Benefit Information Accessible in the IVR Phone System
• Online Enrollment Options in Availity^TM
• Additional Benefit Categories Contained in IVR Phone System
• Careful Documentation Paves the Way for Accurate Coding Capture
• Screening for Hepatitis C
• Appointment Availability and Access Guidelines for Blue Cross Community Centennial Members
• Blue Cross and Blue Shield of New Mexico Managed Care Program Blue Cross Community Centennial Changes, Effective May 20, 2017
• Federal Employee Program Self-Measured Blood Pressure Monitoring
• Member Rights and Responsibilities

June 2017 — Read these articles and more...

• BCBSNM Website
• ClaimsXten^TM Announces Software Version Upgrade
• Receipt of Credentialing Application Notification
• Utilization Management Determinations
• The Importance of Care Coordination
• Insurers Required by CMS to Conduct ACA Risk Adjustment Program Audit
• Benefit Information Accessible in the IVR Phone System
• Online Enrollment Options in Availity^TM
• Appointment Availability and Access Guidelines
• Receipt of Credentialing Application Notification
• Blue Cross and Blue Shield of New Mexico Managed Care Program Blue Cross Community Centennial Changes, Effective May 20, 2017
• Member Rights and Responsibilities
• Billing Medicaid Members
• New Medicare Preauthorization Requirements through eviCore
• Federal Employee Program Self-Measured Blood Pressure Monitoring

May 2017 — Read these articles and more...

• BCBSNM Website
• ClaimsXten^TM Quarterly Updates
• ClaimsXten^TM Announces Software Version Upgrade
• Utilization Management Determinations
• The Importance of Care Coordination
• Insurers Required by CMS to Conduct ACA Risk Adjustment Program Audit
• Benefit Information Accessible in the IVR Phone System
• Online Enrollment Options in Availity^TM
• Appointment Availability and Access Guidelines
• Receipt of Credentialing Application Notification
• Blue Cross and Blue Shield of New Mexico Managed Care Program Blue Cross Community Centennial Changes, Effective May 20, 2017
• Member Rights and Responsibilities
• Billing Medicaid Members
• New Medicare Preauthorization Requirements through eviCore

April 2017 — Read these articles and more...

• BCBSNM Website
• ClaimsXten^TM Quarterly Updates
• Overcoming Barriers to Colorectal Cancer Screening
• The Importance of Care Coordination
• Insurers Required by CMS to Conduct ACA Risk Adjustment Program Audit
• LifeTimes^® Member Newsletter Offers Tips on Preventing Heart Attacks and Strokes
• Appointment Availability and Access Guidelines
• Provider Claim Summary Paper Mailing Discontinuance: Effective Date Delay
• Receipt of Credentialing Application Notification
• Member Rights and Responsibilities
• Billing Medicaid Members
• New Medicare Preauthorization Requirements through eviCore

March 2017  — Read these articles and more...

• ClaimsXten^TM Quarterly Updates
• Kicking the Habit: Helping to Overcome Opioid Addiction in America
• How are You Diagnosing Hypertension
• Availity^TM Claim Research Tool Offers Enhanced Status Results
• Talking with Health Services Staff
• Utilization Management Determinations
• Receipt of Credentialing Application Notification
• Billing Medicaid Members
• Member Rights and Responsibilities
• New Medicare Preauthorization Requirements through eviCore

February 2017  — Read these articles and more...

• Annual Medical Record Data Collection for Quality Reporting begins February 1, 2017
• Receipt of Credentialing Application Notification
• 80% by 2018 Will you commit?
• Preterm Labor Prevention Program
• Additional Code-auditing Software Scheduled for Implementation as of April 30, 2017

January 2017  — Read these articles and more...

• Opiates
• LARC use in Adolescents 15-19
• BCBSNM Vision Plan Transitions to EyeMed - Revisions

December 2016  —  Read this article and more...

• Avoiding Administrative Claim Denials
• Coordination of Care Between Medical and Behavioral Health Providers
• CMS Compliance Program Training Requirements
• CVP Implementation Notice
• Provider Payment and Provider Credentialing Requirement
• Annual Medical Record Data Collection for Quality Reporting begins Feb. 1, 2017

November 2016  — Read these articles and more…

• ClaimsXtenTM Quarterly Updates
• Welcome to Concussion Season
• Flucelvax Quadrivalent Billing Update
• Annual Medical Record Data Collection

October 2016  — Read these articles and more…

• Diabetes Coordination of Care and Blood Glucose Meter Program Updates
• New Preauthorization Requirement for Applied Behavioral Analysis
• Member Rights and Responsibilities
• Special Beginnings^® Maternity Program

August 2016  — Read these articles and more…

• CDC Guidelines for Prescribing Opioids for Chronic Pain
• New Mexico Statewide Pharmacy Standing Order for Naloxone
• Preventive Care Guidelines for Clinicians
• Centennial Care Reminder - Update your Provider Enrollment Information

Due to production delays, the Blue Review was not published in April through July. The monthly publication resumed in August 2016.

March 2016  — Read these articles and more…

• Correction - Telemedicine Reimbursement
• Screening for Hepatitis C
• Pediatric Asthma Intervention Project Results

February 2016  — Read these articles and more…

• New Products Offer More Choices and Potential Savings for BCBSNM Members
• ICD-10 'Coding Basics' Video and Other Resources
• Advance Directives — Not Just a Good Idea

January 2016  — Read these articles and more…

• Implementation Reminder: Three New Facility Rules for ClaimsXten™, Effective Feb. 22, 2016
• Provider Medicare Enrollment Information
• Reduction in Prior Authorization Requirements