May 2017 News! October   2016 News!

Did you miss the San Juan IPA General Membership Meeting?  Well, you missed out!

San Juan IPA provided information about how we are working for you and what to expect in 2017.  We also announced the following two new preferred vendors.

San Juan IPA has partnered with MGMA by purchasing an Organization Membership.  Our relationship with MGMA will benefit both you and your office staff.  MGMA offers a wide variety of educational online courses and seminars.  Course offerings are for:  Physicians, medical practice managers, billing and coding personnel and administrative personnel, directors, clinic leaders, chief executive officers, chief financial officers, accountants, HR, legal, vice presidents, and many others.  To access the MGMA website by going onto the San Juan IPA website at: (click on the MGMA logo).  We encourage you and your staff to take advantage of this opportunity today!

San Juan IPA is working with Safety LLC as preferred vendor for your CPR training needs.  You may contact Greg Brown at 505-860-5727 or via email at: greg@safetynm.comYou may access the Safety LLC website by going onto the San Juan IPA website at: (click on the Safety LLC logo).

The San Juan IPA welcomes our newly credentialed providers:

*New Clinic*

 Rebecca Larivee LCSW has opened her new practice. Larivee Counseling Services 108 N.      Behrend, Ste 1 Farmington, NM 87401 505-327-7582



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 or via phone at 505-564-7980 option 2.  Please note, any members who are not currently contracted with BCBS of NM through the SJIPA and are interested, you may also contact Racquel Johnson. 

All Blue Cross Blue Shield of NM Contracted providers:  Blue Review December 2017

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-part series regarding colorectal cancer screenings
The American Cancer Society and the National Colorectal Cancer Roundtable have pledged to have 80 percent of the population ages 50-75 screened for colon cancer by 2018.
Read more

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 505-837-8800 or 1-800-567-8540.

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-dental providers treating Blue Cross Community CentennialSM members may begin to bill the CPT code 99188 for application of fluoride dental varnish.
Read more

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-entered) into the EVV system, AuthentiCare, will require the agency to gather and maintain supporting documentation.
Read more


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)

In-Home FOBT/FIT & HbA1c Test Kits for FEP Members
Beginning in November some Blue Cross and Blue Shield FEP® members may receive in-home test kits for colorectal cancer screening and/or hemoglobin A1c. Test results will be sent to you to place in member records. Read more

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

Provider Resources

BCBSNM Website
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,, 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

Claims inquiries?
Our Provider Service Unit (PSU) handles all provider inquiries about claims status, eligibility, benefits, and claims processing for BCBSNM members. Call 888-349-3706 For out-of-area claims inquiries, please call the BCBSNM BlueCard PSU at 800-222-7992.
Network Services Contacts and Related Service Areas
Network Services Regional Map

Do we have your correct information?
Maintaining up-to-date contact and practice information helps to ensure that you are receiving critical communications and efficient reimbursement processes. Please complete our quick and easy
online form for any changes to contact or practice 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-patient relationship and the health care delivery process. Read more




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All Cigna Contracted providers:  Submit Pended Claim Documentation Electronically




For Providers
November 2017
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

This new feature on the Cigna for Health Care Professionals website ( 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 > 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 From there, you can upload and submit the requested documentation.

Available to registered users of

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 and click Register Now.

To learn more about this feature, take an eCourse! Simply log in to > Resources > eCourses. You can find the “Submitting attachments for pended claims” eCourse in the “Using this Website” section.

For more information about the website, access levels, and how to register, go to > Learn how to register.


All United Healthcare Contracted providers:  Network Bulletin


Front and Center 

Stay up to date with the latest news and information.

UnitedHealthcare Commercial 

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.

UnitedHealthcare Affiliates 

Learn about updates with our company partners.

State News 

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.

Based on your feedback, we’ve made some changes to the Network Bulletin. Beginning with the December issue, we've incorporated changes that will help you find the information you need in an easier to navigate format.

If you have Internet Explorer as your primary web browser, please ensure it's set as your default browser when clicking on the link above to access the Bulletin. To do so, open Internet Explorer, then go to Tools > Internet Options > Programs > Make Default.

We hope you find the bulletin to be a useful resource. We welcome your feedback at Thank you.

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.


Doc#: PCA-1-008874-11202017_11212017

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.

Insurance coverage provided by or through UnitedHealthcare Insurance Company, All Savers Insurance Company or its affiliates. Health plan coverage provided by UnitedHealthcare of Arizona, Inc., UHC of California DBA UnitedHealthcare Benefits Plan of California, UnitedHealthcare of Colorado, Inc., UnitedHealthcare of Oklahoma, Inc., UnitedHealthcare of Oregon, Inc., UnitedHealthcare of Texas, Inc., UnitedHealthcare Benefits of Texas, Inc., UnitedHealthcare of Utah, Inc. and UnitedHealthcare of Washington, Inc. or other affiliates. Administrative services provided by United HealthCare Services, Inc., OptumRx, OptumHealth Care Solutions, Inc. or its affiliates. Behavioral health products are provided by U.S. Behavioral Health Plan, California (USBHPC), United Behavioral Health (UBH) or its affiliates. 

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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. 

December 2017