All Blue Cross Blue Shield of NM Contracted providers: Ballots
The BCBS of NM contract has been signed by the San Juan IPA as of last Friday. If your office has posted any signs or information about the contract still being outstanding, please be sure to update the information that a contract has been signed.
Effective Monday December 11, 2017 (for all currently contracted providers under the SJIPA) the Ballots have been sent out to our members. If you have not received one please contact Racquel Johnson at firstname.lastname@example.org or via phone at 505-
All Blue Cross Blue Shield of NM Contracted providers: Blue Review December 2017
In this month's Blue Review: Preauthorization updates, Pharmacy updates,
HEDIS and CAHPS results, and more...
Please share this newsletter with others in your group or practice.
2018 Additional Preauthorization Requirements
Beginning Jan.1, 2018, providers will be required to obtain preauthorization through Blue Cross and Blue Shield of New Mexico (BCBSNM) or eviCore for certain procedures as noted below. Read more
“Pulling It All Together” – Colon Cancer Screenings Goal: 80% Participation by 2018
The final article in a 4-
The American Cancer Society and the National Colorectal Cancer Roundtable have pledged to have 80 percent of the population ages 50-
Reimbursement Policy Update Effective Jan. 1, 2018
The purpose of this policy is to provide guidelines for the reimbursement of eligible services appropriately appended with Modifier 52 and Modifier 53 for professional providers. Read more
Pharmacy Program Updates: Quarterly Pharmacy Changes Effective Oct. 1, 2017
Pharmacy updates including: product exclusion from Rx coverage, market withdrawals/product recalls, drug list changes, dispensing limit changes, and utilization management program changes. Read more
Blue Cross Community CentennialSM (Medicaid)
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-
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.
2018 Blue Cross Community Centennial Preauthorization Updates
Beginning Jan.1, 2018, providers will be required to obtain preauthorization through Blue Cross and Blue Shield of New Mexico (BCBSNM) or eviCore for certain procedures for Blue Cross Community Centennial members as noted below. Read more
Service Spotlight: Special Beginnings® Maternity Program
Special Beginnings offers personal, confidential care coordination services to pregnant members during their entire pregnancy. Read more
Updated Diagnosis Related Group Rates
Effective October 1, 2017, Blue Cross and Blue Shield of New Mexico (BCBSNM) updated the Diagnosis Related Group (DRG) rates for Blue Cross Community CentennialSM based on the New Mexico Medicaid Fee Schedules. Read more
New Dental Varnish Billing Code
Effective December 1, 2017, non-
Survey Shows Medicaid Members Give Their Providers High Ratings
Member survey shows high ratings for the healthcare they receive. Learn how we can continue to improve our service to our members. Read more
Looking Back at HEDIS®: Results for HEDIS 2015, 2016, and 2017
We examine the progress we’ve made through the years in providing access to appropriate health care to our Medicaid members. Read more
Our Medicaid Quality Improvement Program
The primary goal of the Medicaid Quality Improvement Program is improved health for our members. We are proud to have met the majority of our goals in 2017 and received NCQA Commendable Accreditation. Read more
Electronic Visit Verification (EVV) Claim Entries Require Supporting Documentation
Effective 1/1/18, any claim that is manually entered (i.e., web-
2018 Blue Cross Medicare AdvantageSM Preauthorization Updates
Beginning Jan.1, 2018, providers will be required to obtain preauthorization through Blue Cross and Blue Shield of New Mexico (BCBSNM), DaVita Medical Group (DMG) or eviCore for certain procedures for Blue Cross Medicare Advantage members as noted below. Read more
Federal Employee Program (FEP)
Beginning in November some Blue Cross and Blue Shield FEP® members may receive in-
2018 FEP Utilization Management Clinical Guideline 002: Inpatient Skilled Nursing Facility Care
Effective January 1, 2018, benefits will be available for Federal Employee Program (FEP) members for up to 30 days of inpatient skilled nursing facility (SNF) care per benefit year for Standard Option Members who are not enrolled in Medicare Part A. Read more
It’s important for you to stay informed about news that could affect your practice. Blue Cross and Blue Shield of New Mexico (BCBSNM) offers many ways to stay informed via our website, bcbsnm.com/provider, and our provider newsletter, Blue Review. Read more
Medical Policy Updates
Approved new or revised Medical Policies and their effective dates are usually posted on our website the first and fifteenth 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.
Our Provider Service Unit (PSU) handles all provider inquiries about claims status, eligibility, benefits, and claims processing for BCBSNM members. Call 888-
Network Services Contacts and Related Service Areas
Network Services Regional Map
Do we have your correct information?
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-
You can find Blue Review online!
We want your feedback on Blue Review! Have suggestions for future articles? Drop us a line anytime: NM_Blue_Review_Editor@bcbsnm.com.
All Cigna Contracted providers: Submit Pended Claim Documentation Electronically
SUBMIT PENDED CLAIM DOCUMENTATION ELECTRONICALLY
View message on web
Now there’s a faster way to submit supporting documentation for your pended claims.
Upload supporting documentation for pended claims through CignaforHCP.com
This new feature on the Cigna for Health Care Professionals website (CignaforHCP.com) allows you to upload supporting documentation for pended claims electronically instead of mailing or faxing it to us.
How does it work?
When you have a pended claim, we will notify you through existing channels, such as fax or mail. You can then view the claim, and the related pend reason code(s), by logging in to CignaforHCP.com > Claims inquiry > Claim detail. Regardless of how you submitted the original claim, if it requires additional information, the upload link will appear on the Claims detail page of CignaforHCP.com. From there, you can upload and submit the requested documentation.
Available to registered users of CignaforHCP.com
Registered users of the website who have access to the Claims Inquiry function can start using the feature right away. If you are not registered, go to CignaforHCP.com and click Register Now.
To learn more about this feature, take an eCourse! Simply log in to CignaforHCP.com > Resources > eCourses. You can find the “Submitting attachments for pended claims” eCourse in the “Using this Website” section.
For more information about the CignaforHCP.com website, access levels, and how to register, go to CignaforHCP.com > Learn how to register.
All United Healthcare Contracted providers: Network Bulletin
Front and Center
Stay up to date with the latest news and information.
Learn about program revisions and requirement updates.
UnitedHealthcare Community Plan
Learn about Medicaid coverage changes and updates.
UnitedHealthcare Medicare Advantage
Learn about Medicare policy and guideline changes.
Learn about updates with our company partners.
Stay up to date with the latest state/regional news.
Tell Us What You Think of Our Communications
As a regular reader of The Network Bulletin, your opinion is important to us. We’d like to get your thoughts about The Bulletin and UnitedHealthcare communications related to network changes, quality initiatives and other issues. Please take a few minutes to complete our survey. Thank you for your time.
Thank you for subscribing to the UnitedHealthcare Network Bulletin. The Bulletin is our monthly publication for participating care providers, featuring timely updates to procedures, programs and policies, and important administrative and clinical information.
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Please note that when information in the Network Bulletin conflicts with applicable state and/or federal law, UnitedHealthcare will follow the applicable and/or federal state law.
If you do not contract directly with UnitedHealthcare, and participate in our network through an arrangement in which we "Lease" a network from some other entity, some of the information provided in this communication may not be applicable to you and/or impact you differently. If you have questions regarding any of the information or need to better understand its impact on you, please contact your local Network Account Representative, Physician Advocate or Hospital & Facility Advocate. If you are not sure who your contact is, please click here.
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Did you know? You are allowed to check a person’s ID to verify the patient matches the benefit card however, if they refuse to allow you to copy or scan it you must comply.