If you have questions, please e-mail us.īlue MedicareRx SM Medicare Part D formulary changes from 2011 to 2012 Visit our Provider Training page for more information and to register. Some of the current training modules are: Why switch to Electronic Refund Management (eRM)?Īs a participating BCBSNM provider, you have the option to use our eRM system for electronic notification/resolution of overpayment requests.īCBSNM offers complimentary educational webinar sessions for our provider community and their staff. If you have any questions about this, please e-mail us. We urge all providers to continue working with their trading partners to ensure they have a plan in place to process V5010 transactions within the enforcement discretion period. To assist those providers who have not completed their conversion, BCBSNM will continue to process both V4010 and V5010 transactions during the enforcement discretion period. The Centers for Medicare & Medicaid Services (CMS) recently announced a 90-day period of enforcement discretion for this mandate. Preauthorization and predetermination processĪll inpatient admissions and air ambulance requests require preauthorization except for emergency admissions.īCBSNM is ANSI Version 5010 (V5010) readyĪs planned and previously announced, BCBSNM is prepared to accept and transmit ANSI V5010 electronic transactions beginning January 1, 2012. In addition, all medical policies are available for review online in the Providers section of. If you have questions about criteria for UM decisions and official medical policy, or if you wish to discuss a UM coverage determination, you may contact a medical director at (505) 816-2093. BCBSNM does not provide any reward or incentive to employees, providers, or other individuals for decisions that result in determinations that services are not covered nor do we reward providers for underutilization of services. Utilization management (UM) determinations are made by licensed clinical personnel based on the benefit policy (coverage) of a member's health plan, evidence-based medical policies, and the medical necessity of care and service. Use of Common Genetic Variants to Predict Risk of Non-Familial Breast Cancerĭiagnosis and Treatment of Chronic Cerebrospinal Venous Insufficiency in Multiple Sclerosis If you have any questions about BCBSNM's Medical Policies, please call Health Services at (505) 816-2093. While information on new or revised Medical Policies is also published in this newsletter for your convenience, please visit our website for access to the most complete and up-to-date information. You may view all active and pending Policies or view draft Medical Policies and provide comments. These policies may impact your reimbursement and your patient's benefits. Thank you!Īpproved new or revised Medical Policies and their effective dates are posted on our website the first day of each month. If you have moved or made other changes to your practice contact information, please complete our quick and easy online form to share your updates with us. Many issues contain articles relevant to department employees, such as system and coding updates, billing and reimbursement, new account groups, federal mandates, and electronic commerce solutions. It is very important that you share Blue Review with your billing departments/entities. Thank you.Įach issue of Blue Review is packed with valuable information. Please distribute this newsletter, which contains claims, billing, Medical Policy, and other important information, to all health care providers and administrative staff that this e-mail address represents. Blue Review - Blue Cross and Blue Shield of New Mexico
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