Blue Review — Provider Newsletter

December 2024 — Read these articles and more...

• Well Child Visits Are Required for Children in State Custody Within 30 Days
• Learn How to Submit Photos to Support Utilization Management Requests
• Accurate Category II Codes May Help Identify Gaps in Care
• Cultural Awareness Webinars: Earn No‑Cost Continuing Education Credit
• Funds to Be Recouped on Some Medicare Advantage Hospital and Ancillary Claims
• Prior Authorization Changes for Government Programs
• Preferred Drugs to Be Recommended Through Enhanced Prior Authorization
• Pharmacy Program Quarterly Update – Part 1
• Clinical Payment and Coding Policy Updates
• Provider Reference Manuals Updated
• Medical Policy Updates
• Nirsevimab Provides RSV Protection for Infants
• Annual Medical Record Review Begins in February 2025

November 2024 — Read these articles and more...

• Risk Identification and Outreach Program Supports Member Safety
• Updates Coming to Behavioral Health Substance Abuse Criteria for Utilization Management
• Submit Itemized Bills or Medical Records for Additional Facility Claims
• Prior Authorization Requirements Are Changing for Some Commercial and Turquoise Care Members
• Billing and Documentation Guidelines for Urine Drug Tests Are Retired
• Remind Our Members That the Flu Vaccine Can Reduce Risks
• Encourage Annual Eye Exams for Members with Diabetes
• Care Coordination May Help Our Members after Hospital Discharges
• Code Effectively to Earn Additional Incentive Payments on Medicare Advantage Claims
• Members May Pay Drug Costs Monthly with New Medicare Prescription Payment Plan
• Check ID Cards for New Coupe Health Plan Members
• Select Self‑Administered Drugs Moving to Pharmacy Benefit
• Pharmacy Program Quarterly Update Changes – Part 2
• Clinical Payment and Coding Policy Updates
• Members May Request Fewer Personal Care Service Hours
• Personal Care Service Agencies Must Meet Caregiver Requirements

October 2024 — Read these articles and more...

• Acquisition of Cigna Healthcare Medicare Business in 2025
• Utilization Management Expanding to Include Site of Care Review of Advanced Imaging for Some Commercial Members
• Use the Updated Claims Referral Form for American Indian/Alaska Native Limited Cost-Share Plans
• Submit Paper Commercial Claims to Correct PO Box to Avoid Delays
• ClaimsXten^TM Quarterly Update
• Breast Cancer Screening Begins at Age 40
• In‑home Test Kits Help Our Members Manage Their Kidney Health
• Register for a Coding Webinar on Coagulation Defects and Other Hematological Disorders
• Clinical Payment and Coding Policy Updates
• Provider Reference Manual Updates
• Health Care Authority Creates a Payment Reform for Primary Care Providers
• Reporting Requirements for Providers Supplying Diabetic Supplies, Equipment and Prescriptions

September 2024 — Read these articles and more...

• Physician Performance Insights Reports Are Now Available
• Clinical Payment and Coding Policy Updates
• Shared Decision‑Making Aids Can Help Guide Care Choices
• Earn Continuing Education Credit at Maternal Mental Health Webinar
• Register for Webinars on Coding for Cancers, Stroke and Heart Failure
• Encourage Medicare Members to Respond to Health Outcomes Survey
• Facility‑Based Providers Have a Credentialing Requirement
• Abiraterone Drug Coverage Changes for Many Commercial Members as of Oct. 1, 2024
• 30‑Day Supply Limit: Select Commercial Members Have New Pharmacy Benefit for GLP‑1 or Anti‑Obesity Drug Therapy
• Pharmacy Program Quarterly Update Changes Effective Oct. 1, 2024 – Part 1
• Medical Policy Updates
• Keep Your Enrollment Status with New Mexico Medicaid Updated
• New EPSDT Clinical Practice and Billing Guideline Is Available
• Learn about Contracting with Turquoise Care
• Employees Provide Needed Supplies to New Mexico Students

August 2024 — Read these articles and more...

• Required Annual Cultural Competency Training Available Virtually
• Has Your Information Changed? Update Us and NPI Registry
• Proper Billing for Supplies for Transcutaneous Electrical Nerve Stimulation Units
• Prior Authorization Updates for Commercial Members Effective Oct. 1
• Check Prior Authorization Requirements for Procedure Codes through Availity^® Essentials or Our IVR System
• Clinical Payment and Coding Policy Updates
• Breast Cancer Screening for Members Ages 40 to 74
• Provider Finder^® to Rank Providers to Help PPO Members Find Care
• Prior Authorization Updates for Medicare Advantage Effective Oct. 1
• Medicare Providers May Treat Blue Cross Group Medicare Advantage Open Access (PPO)^SM Members
• Supporting EPSDT Compliance in School-Based Health Centers

July 2024 — Read these articles and more...

• New Coupe Health Plan: Update Your Member Records
• Updates made to the Provider Reference Manual
• Cultural Awareness Webinars: No-Cost Continuing Education Credit
• Coming Soon — New Learning & Training Center in Availity® Essentials
• Member Rights and Responsibilities
• Provider Rights and Responsibilities
• Prior Authorization Requests May Be Needed Due to Pharmacy Claims Processing Error
• Clinical Payment and Coding Policy Updates
• Our Revised Clinical Payment and Coding Policy for Anesthesia Services Is Now Effective Jan. 1, 2025
• Coding Update: Reimbursement Change for Consultation Services
• Access MCG Care Guidelines Clinical Criteria via Availity
• Encourage Routine Vaccines and Well-Care Visits for Children and Teens
• In-Home Test Kits for Colorectal Cancer Screening
• Physician Performance Insights Reports Coming Soon from PEAQ^SM
• Requests for Behavioral Health Documentation for Medicaid Members
• 2024 NM Annual NDC Drug Fee Schedule Impact and Timeline
• GLP-1 New to Therapy Optional Benefit Program Available for Select Commercial Members
• Notify Us If You Opt Out of Medicare
• New Mexico Medicaid Extends Support to Members Affected by Ruidoso Evacuations
• New Mexico Medicaid Shares Update on Provider Rates
• Resources for Providers Needing Language Assistance for Members
• Keep Your Enrollment Status with New Mexico Medicaid Updated
• Billing Tips for Midwife Providers
• Prenatal and Postpartum Care Coordination Changes for Medicaid Members

June 2024 — Read these articles and more...

• Reminder: Use New Mailing Address
• Important Updates to Manage My Organization in Availity^® Essentials
• New Mexico House Bill 27: Breast Exam Health Coverage
• Electronic Claim Review and Ensuring the Correct Use of our Claim Review Form
• ClaimsXten^TM Quarterly Update Effective Aug. 19, 2024
• Helping Our Members Manage Diabetes
• Updated PEAQ^SM Methodology Is Now Available
• Clinical Payment and Coding Policy Updates
• Behavioral Health Consultations During Hospitalization Can Improve Outcomes
• Pharmacy Program Quarterly Update Changes Effective July 1, 2024 — Part 1
• Closing Gaps in Care for Group Medicare Advantage (PPO) Members
• RSVP for the 2024 Turquoise Care Provider Training Sessions
• Medicaid Transition to Turquoise Care on July 1, 2024
• Turquoise Care Provider Reference Manual

May 2024 — Read these articles and more...

• Updates made to the Provider Reference Manual
• Reporting Requirements for Providers Supplying Diabetic Supplies, Equipment and Prescriptions
• Avoid Directory Suppression: Update your Directory Information such as Accepting New Patients
• Late and Added Charges Must Be Submitted as a Corrected Claim
• 2024 Billing/Documentation Guidelines for Urine Drug Tests
• Prior Authorization Updates
• Coding Webinars: Arrhythmias and Rheumatoid Arthritis
• Supporting Maternal Quality Care
• Clinical Payment and Coding Policy Updates
• Filing Claims for Behavioral Health Services — Use the Correct Place of Service Code
• Pharmacy Program Quarterly Update Changes Effective April 1, 2024 — Part 2
• Updates Made to the Medicare Advantage Provider Reference Manual
• Prior Authorization Updates for Medicare Advantage
• Updates Made to the Provider Reference Manual for Blue Cross Community Centennial
• 2023 Medical Record Review
• Updated: BCBSNM New Process Regarding Legal Responsible Individuals as Caregivers

April 2024 — Read these articles and more...

• Change Healthcare Cybersecurity Incident Impact
• ClaimsXten™ Quarterly Update Effective June 17, 2024
• See Our Revised Clinical Payment and Coding Policy for Anesthesia Services
• Clinical Payment and Coding Policy Updates
• Caring for Substance Use Disorders
• Webinar on Coding for Medicare Advantage Annual Wellness Visits
• Medicare Advantage Coverage of Skilled Nursing Care and Skilled Therapy Services
• RSVP for 2024 Annual Medicaid Provider Training Sessions
• EPSDT Insights & Provider Participation
• Increasing Access to Health Care One Care Van Visit at a Time
• BCBSNM Breaks Ground on Blue Door Neighborhood Center^SM

March 2024 — Read these articles and more...

• Reminder: Update Your Records with New Mailing Addresses for Paper Claims
• Updates made to the Provider Reference Manual
• Federal Employee Program Updates to Prior Approval Requirements and Benefits
• Closing Gaps in Colon Care
• Clinical Payment and Coding Policy Updates
• Follow-up Care for Mental Health
• Avoiding the Inappropriate Use of Antipsychotic Medication in Anxiety Disorders
• Pharmacy Program Quarterly Update Changes Effective April 1, 2024 — Part 1
• Medicare Advantage HEDIS Records Collection through June 2024
• Updates Made to the Blue Cross Community Centennial Provider Reference Manual
• Blue Cross Community Centennial Members Rate Their Experience
• Blue Cross Community Centennial Quality Improvement Program
• New Mexico Medicaid Team Provides Prenatal Outreach to High-Risk Mothers

February 2024 — Read these articles and more...

• Changes Coming to Claim Inquiry Resolution — High-Dollar, Pre-Pay Reviews Only
• Provider Onboarding Process Update
• Blue Cross and Blue Shield Federal Employee Program^® HEDIS^® Records: Collecting February through April 2024
• Join Our Quality Improvement Committee: Provider Opportunity at BCBSNM
• 2023 Annual HEDIS Medical Record Review Begins February 2024
• Prior Authorization Updates
• ClaimsXtenTM Quarterly Update Effective April 15, 2024
• Coding Webinars: Major Depressive Disorder and Annual Wellness Visits
• Utilization Management: How to Avoid Delays and Denied Claims
• Managing Antidepressant Medication
• Supporting Healthy Hearts
• Clinical Payment and Coding Policy Updates
• Appropriate Use of Opioids Program to be Retired January 2024
• Pharmacy Program Quarterly Update Changes Effective Jan. 1, 2024 — Part 2
• Prior Authorization Updates for Medicare
• Centers for Medicare and Medicaid Services guidelines for Availability and Access Standards to Care for Medicare Advantage Members
• BCBSNM New Process Regarding Legal Responsible Individuals as Caregivers
• New Mexico Kids Matter Receives Grant from BCBSNM to Support Teens in Foster Care

January 2024 — Read these articles and more...

• Reminder: Update Your Records with New Mailing Addresses for Paper Claims
• Updates made to the Provider Reference Manual
• Advisory on Telemedicine Services — Using Place of Service Codes on Commercial Claims
• Prior Authorization Updates
• Three New ClaimsXten^TM Rules to be Implemented March 2024
• Reminder: See Updates to Claim Editing Changes for Emergency Department Services
• Clinical Payment and Coding Policy Updates
• Monitoring Children Using ADHD Medication
• Remind Our Members about Cervical and Breast Cancer Screenings
• Oral Oncology Pharmacy Network Transitioned to IntegratedRx^TM
• BCBSNM’s Approach to Managing GLP-1 Agonist Medications
• Updates Made to the Blue Cross Medicare Advantage Provider Reference Manual
• Prior Authorization Updates for Medicare
• Patients in the Qualified Medicare Beneficiary Program Should Not Be Billed
• Hospitals Must Provide Medicare Outpatient Observation Notice
• Update Your Records: New Medicare Open Access PPO Members and ID Cards
• Updates Made to the Blue Cross Community Centennial Provider Reference Manual
• Zuni Youth Enrichment Project Receives Grant from BCBSNM to Improve Health Outcomes for Zuni Residents

December 2023 — Read these articles and more...

• Updates Made to the Provider Reference Manual
• Chronic Kidney Disease Management Strategies for Primary Care Providers
• Reimbursement Rate Update for Some Commercial ABA Codes
• New Email Address for Electronic Commerce Services
• See Updates to Claim Editing Changes for Emergency Department Services
• Encourage Annual Eye Exams for Members with Diabetes
• Clinical Payment and Coding Policy Updates
• Training Resources for Behavioral Health Care
• Pharmacy Program Quarterly Update Changes Effective Jan. 1, 2024 — Part 1
• Updates Made to the Blue Cross Medicare Advantage Provider Reference Manual
• Medical Records Reminder for Out-of-Area Medicare Advantage Members
• Blue Cross Medicare Advantage Dual Care Plus^SM 2022 Program Summary
• Blue Cross Medicare Advantage Dual Care Plus Preferred 2022 Program Summary
• Rate Increase for After Hours/Weekend Well Child Visits
• Updates Made to the Blue Cross Community Centennial Provider Reference Manual
• BCBSNM Will Open a Blue Door Neighborhood Center in the South Valley

November 2023 — Read these articles and more...

• Provider Finder^® to Highlight ‘Top Performing Physicians’
• Join Us for a Webinar on Coding for Vascular Disease
• New CPT^® Codes for COVID-19 Vaccines and Vaccine Administration
• Clinical Payment and Coding Policy Updates
• Coordinating Care after Hospital Discharges to Help Reduce the Chances of Readmissions
• What You Need to Know About the Flu Season
• Remember: New Enhancements for Behavioral Health Preservice Review Requests
• BlueApprovR^SM Now Accepts Recommended Clinical Reviews for Behavioral Health — Attend a Training
• Pharmacy Program Updates: Quarterly Pharmacy Changes Effective Oct. 1, 2023 – Part 2
• Musculoskeletal Category Expansion, Code Removals and other Prior Authorization Updates, Effective Jan. 1, 2024
• Medical Oncology, Radiation Oncology Care Category Removal from eviCore and other Prior Authorization Updates for Medicare Jan. 1
• Medicare Advantage Members to Transition to BCBSNM Kidney Care Program
• RSVP for 2023 Annual Medicaid Provider Training Sessions
• BCBSNM Will Implement a New Process for Member-Driven PCS Hour Decreases
• Temporary Economic Recovery Payment Increase for Home and Community Based Services — LOD #79-1
• Expiration of the Public Health Emergency — Prior Authorization for ABA Services
• Blue Cross and Blue Shield of New Mexico Teams Up With National Fitness Campaign to Bring Outdoor Fitness Courts Across New Mexico

October 2023 — Read these articles and more...

• BCBSNM Receives Notification of Intent to Award Turquoise Care Contract
• New Mailing Addresses for Paper Claims
• Updates made to the Provider Reference Manual
• ClaimsXten^TM Quarterly Update Effective Dec. 4, 2023
• Inpatient DRG claims for patients transferred early will be paid according to CMS’ transfer policy
• Reminder for Billing Point-Of-Use Convenience Kits
• Clinical Payment and Coding Policy Updates
• Updates to Clinical Practice and Preventive Care Guidelines
• BlueApprovR^SM Now Accepts Recommended Clinical Reviews — Attend a Training
• Supporting Quality Care During Breast Cancer Awareness Month
• See New Enhancements for Behavioral Health Pre-service Reviews
• Select Medication List to be Discontinued
• Updates Made to the Blue Cross Medicare Advantage Provider Reference Manual
• Current Procedural Terminology (CPT^®) Codes Updated for Prior Authorization for Medicare Oct. 1
• Survey Assesses Medicare Advantage Members’ Health Outcomes
• Updates Made to the Blue Cross Community Centennial Provider Reference Manual 
• Blue Cross and Blue Shield of New Mexico Awarded NCQA Long-Term Services and Support Distinction

September 2023 — Read these articles and more...

• Transition from required Prior Authorization to Recommended Clinical Review Effective Sept. 18, 2023
• Reporting On-Demand via Availity^® Essentials is Now Named Provider Claim Summary
• Shared Decision-Making Aids Can Help Guide Care Choices
• Claim Editing Changes for Emergency Department Services Coming Nov. 1, 2023
• Submitting Claims for Infertility Services
• Clinical Payment and Coding Policy Updates
• Pharmacy Program Updates: Quarterly Pharmacy Changes Effective Oct. 1, 2023 — Part 1
• Medical Records Reminder for Out-of-Area Medicare Advantage Members
• Expiration of the Public Health Emergency
• New Mexico Medicaid Provider Engagement Forum

August 2023 — Read these articles and more...

• Updates made to the Provider Reference Manual
• Webinar on Coding for Morbid and Severe Obesity
• Introducing Claim Reconsideration Requests via Availity^® Essentials
• Prior Authorization Codes Updated, Effective Oct. 1, 2023
• PEAQ^SM Physician Performance Insight Reports are Coming Soon
• In-Home Test Kits for Colorectal Cancer Screening
• Statin Therapy for Patients with Cardiovascular Disease and Diabetes
• See Our Revised Preventive Services Clinical Payment and Coding Policy Effective July 1, 2023
• Clinical Payment and Coding Policy Updates
• Direction from Centers for Medicare & Medicaid Services (CMS) regarding enrollment requirements for prescribing pharmacists or pharmacy providers under Medicaid
• Pharmacy Program Updates: Quarterly Pharmacy Changes Effective July 1, 2023 — Part 2
• Current Procedural Terminology (CPT^®) Codes Updated for Prior Authorization for Medicare Oct. 1

July 2023 — Read these articles and more...

• Letter of Direction (LOD) #85 — Community Benefit Provider Audits
• Updates made to the Provider Reference Manual
• Webinars on Cross-Cultural Care Offer Continuing Education Credit
• Blue Community HMO Network^SM (CNN) — Individual On and Off Exchange Plans
• New Availity^® Eligibility & Benefits Experience
• Provider Access and Availability Survey
• Member Rights and Responsibilities
• Provider Rights and Responsibilities
• ClaimsXten^TM Announces Software Version Upgrade
• Catch Up on Routine Vaccines and Well-Child Visits
• Clinical Payment and Coding Policy Updates
• Prior Authorization Codes Updated, Effective July 1
• Current Procedural Terminology (CPT^®) Codes Updated for Prior Authorization for Medicare and Medicaid Programs, July 1
• Blue Cross Medicare Advantage Dual Care Plus (HMO SNP)^SM 2021 Program Summary
• Medicare Providers May Treat Medicare Advantage Flex and Group Medicare Advantage Open Access PPO Members

June 2023 — Read these articles and more...

• PEAQ^SM Provider Performance Insights Coming Soon
• BlueApprovR^SM Expedites Medical Surgical, Pharmacy and Behavioral Health Prior Authorization — Attend a Training
• Coverage for Telemedicine Services when the Public Health Emergency Ends May 11
• Updates made to the Provider Reference Manual
• Earn Continuing Education Credit at a Webinar on Avoiding Inappropriate Antibiotic Use
• ClaimsXten^TM Quarterly Update Effective August 21, 2023
• 2023 NM Annual NDC Drug Fee Schedule Impact and Timeline
• Helping Our Members Manage Diabetes
• See our New Clinical Payment and Coding Policy for Outpatient Facility Services that Overlap During an Inpatient Stay
• Clinical Payment and Coding Policy Updates 
• Members Can Now Access Network of Pharmacies at Accredited Cystic Fibrosis Treatment Centers
• Pharmacy Program Updates: Quarterly Pharmacy Changes Effective July 1, 2023
• Updates Made to the Blue Cross Medicare Advantage Provider Reference Manual
• Medical Records Reminder for Out-of-Area Medicare Advantage Members
• Updates Made to the Blue Cross Community Centennial Provider Reference Manual

May 2023 — Read these articles and more...

• BlueApprovR^SM Expedites Medical Surgical, Pharmacy and Behavioral Health Prior Authorization — Attend a Training
• Updates made to the Provider Reference Manual
• Webinar on Coding for Chronic Kidney Disease
• Annual Regulatory Survey of BCBSNM Provider Directories
• Prior Authorization Codes Updated, Effective July 1, also watch for Medical Oncology Portal Enhancements
• Current Procedural Terminology (CPT^®) Codes Updated for Prior Authorization for Medicare and Medicaid programs, July 1
• New Support Program for Members with Kidney Disease
• Track Care Visits During and After Pregnancy
• See our New Three-day Payment Policy for Outpatient Services Prior to an Inpatient Admission
• Clinical Payment and Coding Policy Updates
• Behavioral Health Consultations During Hospitalization Can Improve Outcomes
• Pharmacy Program Updates: Quarterly Pharmacy Changes Effective April 1, 2023 — Part 2
• 2022 Medical Record Review

April 2023 — Read these articles and more...

• AIM Specialty Health Changes Its Name to Carelon Medical Benefits Management
• BCBSNM Engaged Hospital Service Corporation for Site Visits
• Earn Continuing Education Credit through Webinar on Opioids
• See Changes to our Existing Inpatient Readmission Policy for Some Commercial Members
• Monitoring Children Using ADHD Medications
• Caring for Substance Use Disorders
• Screening and Follow-Up Care for Maternal Mental Health
• New for 2023: Specialty Pharmacies Added In-Network
• Pharmacy Program Updates: Quarterly Pharmacy Changes Effective January 1, 2023 — Part 2

March 2023 — Read these articles and more...

• New Blue ApprovR^SM Expedites Some Prior Authorizations — Attend a Training to Learn More
• Updates made to the Provider Reference Manual
• Earn Continuing Education Credit through Webinar on Bipolar Disorder
• Cultural Awareness Webinars: Earn Continuing Education Credit
• Verify Your Directory Details Every 90 Days
• Provider Onboarding Form Requirement
• Closing Gaps in Colon Care
• Clinical Payment and Coding Policy Updates
• Quality Care: Screening for Depression
• Pharmacy Program Updates: Quarterly Pharmacy Changes Effective April 1, 2023 — Part 1
• Help Close Gaps in Care for Group Medicare Advantage Members
• Survey to Assess Medicare Advantage Members’ Experiences
• Updates Made to the Blue Cross Medicare Advantage Provider Reference Manual
• COVID-19 Public Health Emergency Ending
• New Mexico Human Services Department Issues Supplement #22-12
• Updates Made to the Blue Cross Community Centennial Provider Reference Manual

February 2023 — Read these articles and more...

• FEP^® Annual Medical Record Data Collection for Quality Reporting — HEDIS^®
• Updates made to the Provider Reference Manual
• Prior Authorization Codes Updated, Effective April 1
• Current Procedural Terminology (CPT^®) Codes Updated for Prior Authorization for Medicare and Medicaid programs, April 1
• ClaimsXten^SM Quarterly Update Effective April 17, 2023
• Supporting Heart Health Equity
• Predetermination is now Recommended Clinical Review
• Clinical Payment and Coding Policy Updates
• Inflation Reduction Act to Impact Insulin and Vaccine Costs for Medicare Members
• Blue Cross Medicare Advantage Dual Care Plus (HMO SNP)^SM 2020 Program Summary
• Updates Made to the Blue Cross Medicare Advantage^SM Provider Reference Manual
• Updates Made to the Blue Cross Community Centennial^SM Provider Reference Manual

January 2023 — Read these articles and more...

• Prior Authorization Codes Updated, Effective January 1
• Current Procedural Terminology (CPT^®) Codes Updated for Prior Authorization for Medicare programs
• Cervical and Breast Cancer Screenings
• Clinical Payment and Coding Policy Updates
• Patients in the Qualified Medicare Beneficiary Program Should Not Be Billed
• Hospitals Must Provide Medicare Outpatient Observation Notice
• Centennial Care Behavioral Health Screening Incentive Program
• Blue Cross Community Centennial Members Rate Their Experience
• Our Blue Cross Community Centennial Quality Improvement Program