Pharmacy program update: Utilization management transition The BCBSNM pharmacy optimization initiative includes a number of strategies to help improve the value of our drug benefits, monitor drug safety, and ultimately improve health outcomes for our members. View full story BCBSNM condition management programs support physicians Our condition management (DM) programs are based on the belief that to optimize health outcomes, patients with chronic health conditions are best served by a collaboration of their physician's professional clinical care and self-care (the actions patients take to manage their conditions). View full story Fax option to be removed for high-tech imaging order entry requests Please note that as of January 1, 2012, all RQI number requests must be submitted online or by telephone, as AIM will no longer be supporting fax requests. (The fax option will remain available for physicians who are submitting clinical information for existing requests.) View full story Medical record requests: Include our letter as your cover sheet When you receive a letter from BCBSNM requesting additional information such as medical records or certificates of medical necessity, please use the letter as a cover sheet when sending the requested information to us. This letter contains a barcode in the upper right corner of the page to help ensure that the information you send is matched directly to the appropriate file and/or claim. Do not submit a Claim Review Form in addition to the letter, as this could delay the review process. Thank you for your cooperation! ANSI Version 5010 (v5010) compliance reminders We're including a summary of ANSI v5010-related billing changes and testing reminders from previous Blue Review articles to call your attention to these important details. If you use the services of a billing entity (a billing service and/or clearinghouse), please be sure to check with them to help ensure that they are fully prepared to conduct and/or support ANSI v5010 transactions submitted on your behalf. View full story Electronic funds transfer (EFT) helps protect your claim payments The EFT Agreement you sign with us prevents BCBSNM from debiting your bank account to satisfy payment obligations. Any recoupment deductions must be made prior to release of payments we are sending you, and not from your bank account. View full story Behavioral health providers: Save time — go online! Every moment counts, especially when your patients are waiting. Setting aside time to make phone calls to BCBSNM can present an administrative challenge. Electronic options allow you to go online at your convenience to obtain patient eligibility and benefits, check claim status, and conduct other claim-related inquiries. View full story Online member liability estimator now available The Availity® CareCost EstimatorSM (CCE), developed jointly with Availity, is a member liability estimator* (MLE) tool. The CCE reviews the available information submitted: Primary diagnosis, procedures performed, available benefits, and contractual allowances. Then it calculates an estimated out-of-pocket cost in real time for office and outpatient services provided to BCBSNM members. View full story CHILI: Child-Health Immunization Learning Initiative The goal of the New Mexico Department of Health (DOH) Immunization Program is to ensure that all New Mexicans are properly immunized against vaccine-preventable diseases. The DOH offers CHILI, a comprehensive training course, taught by DOH nurses specially trained in regional immunization. Course topics include: |