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BLUE Review
Issue 6 – 2008 • November/December Blue Review going paperless in 2009
As a part of our corporate "Blue Goes Green" initiative, To sign up for Blue Review via e-mail, click the Update we are collecting e-mail addresses of the more than Your Contact Information button at bcbsnm.com
10,500 contracting providers in our networks.* We will /providers and submit your e-mail address. Please
use these e-mails to launch our electronic-only version include your NPI.
of Blue Review in 2009. We invite you to join us in"Blue Goes Green" by choosing to receive your Blue *BCBSNM is aware of your privacy concerns and ensures that your Review via e-mail.
e-mail address is maintained in a secure environment and held in thestrictest confidence.
By e-mailing communications to our providers, we canreduce paper use significantly, thereby acknowledgingour responsibility as corporate citizens to safeguard natu-ral resources and the environment. "Losing the paper"will give you quicker access to BCBSNM informationand make distribution easier – just forward the newslet-ter to your staff. Also, when you get your newsletter viae-mail, you'll receive quick links to other new items onour provider website.
Beginning with issue 1, 2009, the next issue, Blue Review
will be a monthly publication available at bcbsnm.com.
To find it, click the Blue Review button on the Providers
home page. During the first quarter of 2009, we will mail
postcards to all contracted providers informing them
that the latest issue is available and what some of the
key articles are. If you do not have Internet access,
please contact Network Management at 800-567-8540
to continue receiving Blue Review by mail.
2008 Provider Satisfaction Survey results
This summer, BCBSNM conducted its annual provider alty, 81 percent of providers were either "very satisfied" satisfaction survey, which was administered by The or "satisfied" with BCBSNM. We are particularly Myers Group, an independent consultant. The Myers pleased that 93.2 percent of physicians would recom- Group collected responses from a random sampling of mend BCBSNM to other physicians and 92.9 percent participating BCBSNM providers on such areas as cus- would recommend our plan to other patients.
tomer service, provider relations, utilization and qualitymanagement, finance, pharmacy and drug benefits, con- Look for detailed information on the survey results in tinuity and coordination of care, and overall provider the January 2009 issue of Blue Review. We value your continued feedback.
Results are still being compiled, but we already havesome overall percentages. In overall satisfaction and loy- BCBSNM welcomes Medicaid program staff
On October 1, BCBSNM launched BlueSaludSM to provide comprehensive health care benefits for the Medicaid-
eligible population in New Mexico. Mary Winters Morse oversees BlueSalud as Director of Medicaid Programs.
Mary's background in health care management spans 35 years and includes the administration of the largest freestand-ing Medicare-certified home health care agency in New Mexico. "Because of my experience as a health care adminis-trator," Mary says, "I understand the provider per-spective and the challenges they face. Some of thosechallenges with BlueSalud will be developing cultur-al awareness and overcoming language barriers." Mary says her two biggest challenges in serving theBlueSalud membership will be ensuring adequateaccess to primary care and specialist providers andsteady membership growth. BCBSNM is committedto wellness and serving the community, and Maryintends to further that commitment through theBlueSalud program.
Mary is a registered nurse and worked at BCBSNMfrom 1977 to 1991. Before returning to BCBSNM,she served as Director of Quality Management andMedicaid Compliance Officer at Presbyterian HealthPlan. Mary holds a B.S. in health care administra-tion from University of Albuquerque and an M.B.A.
from the University of Phoenix.
Angela Sanchez-Caldwell joined BCBSNM as the Medicaid
contractor in August. She brings more than 15 years of health
care administration experience to Network Services.
Contracting allows her to continue working with the provider
community, where she has developed many friendships over the
years. "Developing long-term relationships in the provider com-
munity is important," says Angela. "These partnerships have
made it a pleasure to come to work every day."
Angela says of BCBSNM, "I have never encountered a morewelcoming group of people, and their commitment to work as ateam to accomplish a common goal is to be commended. Thething that really stands out with BCBSNM is the desire to pro-vide outstanding service to customers." Angela offers this advice to participating BlueSalud providers:"Build strong relationships with your BCBSNM contacts.
Together we can provide better care for our BlueSalud members." BLUE Review
Issue 6 - 2008
EPSDT program for BlueSalud members
The Early Periodic Screening, Diagnosis, and Treatment program (EPSDT) is federally mandated to ensure compre-hensive health care to Medicaid recipients from birth to 21 years of age. To help this population of BlueSalud mem-bers receive health care, BCBSNM covers medically necessary prevention, treatment, and ameliorative health servicesunder EPSDT.
Services provided under EPSDT can be accessed only after an initial health screening service, called the "tot-to-teenhealthcheck" or "healthcheck referral." EPSDT services include: • Comprehensive health and development history*• Comprehensive unclothed physical exam*• Appropriate immunizations*• Laboratory tests, including an appropriate lead blood level assessment at 12 and 24 months of age*• Health education*• Dental screening• Vision and hearing testing *These services must be documented to fulfill EPSDT exam requirements and to allow us to measure clinical processesusing the Healthcare Effectiveness Data and Information Set (HEDIS®). Accurate HEDIS reporting is importantbecause it will be used as part of a BlueSalud performance recognition strategy currently in development.
HEDIS® is a registered trademark of the National Committee for Quality Assurance.
CPT codes for EPSDT visits
The Centers for Medicare and Medicaid Services (CMS) has mandated that the following CPT-4 codes be used to
capture all EPSDT visits:
• 99381 New patient (under 1 year)• 99382 New patient (1-4 years)• 99383 New patient (5-11 years)• 99384 New patient (12-17 years)• 99385 New patient (18-39 years)• 99391 Established patients (under 1 year)• 99392 Established patients (1-4 years)• 99393 Established patients (5-11 years)• 99394 Established patients (12-17 years)• 99395 Established patients (18-39 years)• 99431 Newborn care (history and examination)• 99432 Normal newborn care In addition, the above CPT-4 codes must be used in conjunction with V codes V20 through V20.2 and/or V70.0 andV70.3 through V70.9: • V20 Health supervision of infant or child• V20.0 Foundling• V20.1 Other healthy infant or child receiving care• V20.2 Routine infant or child health check• V70.0 Routine medical examination at a health care facility• V70.3 Other medical examination for administrative purposes• V70.4 Examination for medicalogical reasons• V70.5 Health examination of defined populations• V70.6 Health examination in population surveys• V70.7 Examination for normal comparison or control in clinical research• V70.8 Other specified general medical examinations• V70.9 Unspecified general medical examination BLUE Review
Issue 6 - 2008
Medical Policy updates
Approved new or revised Medical Policies and their effective dates are posted on our website the first day of each
month. These policies may impact your reimbursement and your patients' benefits. To View All Active Policies or View All
Pending Policies, visit the Provider Library at bcbsnm.com under Medical Policies. Select Draft Medical Policies to view
policies that are under development or are being revised and e-mail your comments.
Some information about new or revised Medical Policies is also published in this newsletter for your convenience.
However, please rely on our website for access to the most complete and up-to-date Medical Policy information. If you
have questions about BCBSNM's Medical Policies, please contact Health Services at (505) 816-2093.
Eff. date Policy #
Policy name
Intravascular Brachytherapy for Prevention and Management of Restenosis afterPrecutaneous Transluminal Angioplasty Accelerated Partial Breast Irradiation (APBI) Neovascular Wet Age-Related Macular Degeneration (ARMD or AMD) Epiretinal Radiation Therapy for Age-Related Macular Degeneration (ARMD) Prosthetics, Except Lower Limb Prosthetics Lower Limb Prosthetics, Including Microprocessor Prosthetics Percutaneous and Implanted Nerve Stimulation and Neuromodulation Collagen Cross Links as Markers of Bone Turnover Electromagnetic Navigation Bronchoscopy (ENB) Breast Ductal Lavage, Endoscopy, or Ductoscopy Non-Pharmacologic Treatment of Rosacea CT (Computed tomography) Perfusion Imaging Automatic Implantable Cardioverter Defibrillator Minimally Invasive Percutaneous Facet Joint Fusion (TruFUSE) Drug List updates
The BCBSNM and Prime Therapeutics Pharmacy and Therapeutics Committee met on August 25, 2008, and recom-
mended the following changes to the BCBSNM Drug List. To search the Drug List and learn more about BCBSNM
drug benefits, including pharmaceutical management procedures such as prior authorization, step therapy, and dispens-
ing limits, go to bcbsnm.com and select Providers, then scroll down to Pharmacy.
Brand-name medications added to third-tier copay
Effective October 1, 2008
Effective October 1, 2008
Third-tier brand Second-tier alternatives
First-tier generic alternatives
Pristiq® (30 tablets/30 days) Actonel®, Evista® alendronate (Fosamax) omeprazole 40 mg (30 caplets/30 days) estradiol patches (Climara®) ramipril, lisinopril, enalapri Effective January 1, 2009
Seroquel®, Geodon® Brand-name medications added to second-tier copay Effective October 1, 2008
New second-tier medication
BLUE Review
Issue 6 - 2008
OFFICE Staff
Issue 6 – 2008 • November/December Expediting paper claims processing
Here are four tips to help your paper claims process more
4. Check out our helpful reference guides.
For a printable CMS-1500 or UB-04 User Guide, and an 1. Use the proper version of the claim form.
online CMS-1500 tutorial, visit the Provider Library on BCBSNM is no longer accepting the old version of the our website at bcbsnm.com. Additional information on
CMS-1500 (version 12/90 and/or HCFA form) or the the CMS-1500 claim form can be found on the National UB-92 claim form. Claims received on these outdated Uniform Claim Committee (NUCC) website at forms will be returned to you. Please recycle any old nucc.org. For complete detailed information on the
forms in your inventory and replace them with the cur- UB-04 claim form, visit the National Uniform Billing rent version. The current versions of these forms are Committee (NUBC) website at nubc.org.
CMS-1500 (version 08/05) and UB-04.
2. Include all required identification information.
In addition to including the appropriate member identifi-
cation, such as the group policy number and alpha-prefix
identification number, it is important to include your
Type 1 and/or Type 2 NPI in all appropriate fields. (Note:
Your billing NPI must be included in field 33a on the
CMS-1500 and in Form Locator 56 of the UB-04.) Your
taxpayer identification number (SSN, EIN, or TIN) will
continue to be required on all claims for tax reporting
purposes. Claims that are missing any required informa-
tion will be returned to you with a cover letter explain-
ing the reason for return.
3. Provide readable originals.
Use only the original, standard red-ink claim form. This
form is printed with a special red ink to ensure proper
scanning. If the form is not scanned properly, errors or
processing delays could occur. Claims that are partially
legible, too light, or too dark will be returned to you.
Find the forms you need at bcbsnm.com
Use the Forms section of our online Provider Library to
In our ongoing effort to improve our processes and service, obtain the most updated version of the document you the forms and other information on our website are updat- need. We see many instances where providers are using old ed frequently. Rather than printing multiple copies of a versions of forms. When you use an outdated form, we may form, or saving the PDF to your hard drive, please go to not receive the information we need to expedite your bcbsnm.com each time to obtain the form you need, there-
by ensuring you have the most current version.
BLUE Review
OFFICE Staff, continued
Claims inquiries? Call the Provider Service Unit (PSU) at 888-349-3706
Our PSU handles all provider inquiries regarding claims status, eligibility, benefits, and claims processing issues for
BCBSNM members. For out-of-area claims inquiries, please call the BlueCard® Provider Service Unit at 800-222-7992.
Network Management contacts and related service areas
PROVIDER SERVICE REPRESENTATIVES
Handle general questions on contracting
Including allied health practitioners
and provider education
Our Provider Service Representatives are available to assist you Monday through Friday, 8 a.m. to 5 p.m.
Northwest Region Network Contract Rep: JoAnn Ireland
General department telephone numbers:
Telephone: (505) 816-2159
(505) 837-8800 or toll-free: 800-567-8540
Direct fax numbers:
Northeast Region Network Contract Rep: Joyce Hamblet
(505) 816-2688 or toll-free: 866-290-7718
Telephone: (505) 816-2146
Lead Provider Rep: Gina Gutierrez
Including acute care, behavioral health,
Telephone: (505) 816-2156
and speciality hospitals
Network Contract Rep: Mike Nelson
Telephone: (505) 816-2139
Network Contract Rep: Michelle Quintero
Lead Provider Rep: Gina Gutierrez
Telephone: (505) 816-2158
Telephone: (505) 816-2156
Lead Provider Rep: Liz Martinez
Telephone: (505) 816-2161
Medicaid and Medicare Advantage
Southwest Region Network Contract Rep: Karen Burgess
Blue Medicare PPO Network Contract Rep:
Telephone: (505) 816-2282
Cathie Rowland-Robert Telephone: (505) 816-2132
Southeast Region (includes Harding and Union Counties)
Network Contract Rep: Jill Billingsley
BlueSalud Network Contract Rep:
Telephone: (505) 816-2143
Angela Sanchez-Caldwell Telephone: (505) 816-2038
Lead Provider Rep: Jan Montoya
Telephone: (505) 816-2303
Network Contract Rep: Rick Bogle
Telephone: (505) 816-2145
Lead Provider Rep: Jan Montoya
Telephone: (505) 816-2303
OFFICE Staff continued on p. 8 ✂
BLUE Review
Issue 6 - 2008
Blue Medicare PPOSMCorner
Issue 6 – 2008 • November/December Don't forget your CLIA number when billing for lab work
Blue Medicare PPO follows the same billing and coverage guidelines as original Medicare. This includes the require-
ment to report the Clinical Laboratory Improvement Amendments (CLIA) number on claims submitted by all laborato-
ries, including physician office laboratories.
Your CLIA number is required on the CMS-1500 (08/05) claim form for lab services by any lab performing tests cov-ered by CLIA. Be sure to: • Place the CLIA number in field 23 of the paper CMS-1500 (08/05)
• Ensure that the CLIA number is included with all electronic filings
• Include modifier QW on claims for CLIA-waived lab tests
Your CLIA number is not required for the CMS-1450 (UB04) claim form.
New! Blue Medicare PPO provider portal
Blue Medicare PPO will have a separate, standalone provider portal before the end of 2008. Blue Medicare PPO
providers will have the ability to verify Blue Medicare PPO member benefits and eligibility online, as well as check
claims status and payment.
To use the portal, providers must have a high-speed Internet connection and an Internet browser that supports 128-bitencryption (Microsoft Internet Explorer 6.0 or greater is required). The portal will be best experienced with a 800x600or greater pixel screen resolution and when Frames, Graphics, and Java browser settings are enabled.
Providers may call Blue Medicare PPO provider Customer Service for registration instructions at 866-706-7745.
Not yet contracted for
Blue Medicare PPO?
Providers who are participating in commercial
BCBSNM products are not automatically consid-
ered participating providers in Blue Medicare PPO.
They must sign a Medicare Advantage amendment
to their Medical Services Entity Agreement
(MSEA) to become a Blue Medicare PPO provider.
Please call Cathie Rowland-Robert at (505) 816-
2132 if you are interested in becoming a Blue
Medicare PPO provider.
BLUE Review
Continued from OFFICE Staff, p. 6
Additions to our provider network
High Desert Nephrology Associates, PLLC
Bloomfield Chiropractic Center, Inc.
1801 Red Rock Drive 308 North First Street Bloomfield, NM 87413 2009 Blues Provider Reference Manual
Look for new sections in the Blues Provider Reference
To access a copy of the PRM, go to bcbsnm.com and Manual (PRM) for 2009. We are adding sections on e- select Providers, then Provider Reference Manual under business and network management and are giving cre- the Provider Library heading. Providers without access dentialing its own section. We've also added hyperlinks to the website may order a hard copy from Network for the online version and more attachments to make Services by calling (505) 837-8800 or 800-
the PRM more user-friendly. The PRM is updated throughout the year, but we will
add the new sections and updated attachments by
January 2009. You can find those changes summarized in
Provider Reference Manual Changes in the Providers
section of our website, bcbsnm.com. Keep this section
bookmarked for the latest updates.
Checklist for requesting appeals on a member's behalf
A provider who specifically states that he or she is submitting an appeal on behalf of the member as an authorized rep-resentative must submit the information listed below before BCBSNM will accept the appeal request.
Written authorization must be included with each appeal filed by an authorized representative. Use the "Provider
Request for Appeal on Behalf of the Member" form, available from bcbsnm.com/providers – select Forms under
Provider Library. The authorization must include:
1. Member signature2. Member's acknowledgment authorizing the representative to appeal on his or her behalf3. Pertinent claim information, including: • Cardholder name, address, and phone• Copies of explanation of benefits (EOB), remittance advice, and/or denial letter Send appeals requests to:
• Date(s) of service Blue Cross and Blue Shield of New Mexico • BCBSNM identification number Attn: Appeals Department • BCBSNM group/enrollment number Albuquerque, NM 87125-7630 • Provider name• Provider NPI number BLUE Review
Issue 6 - 2008
Triessent is new Specialty Pharmacy vendor
BCBSNM has recently chosen TriessentTM, a new program offered by Prime Therapeutics®, as the exclusive provider of
specialty medications for its members. Members currently on specialty medications will be transitioned from McKesson
to Triessent effective November 1, 2008.
Triessent is a full-service Specialty Pharmacy and will provide physician offices with the following services: • Custom fax forms for simplified enrollment• Alerts for patient nonadherence issues• Assistance with paperwork and coverage options• Verification of patient eligibility• Toll-free helpline available 24/7• Batched delivery directly to your office, usually within 24 to 48 hours• Full inventory of specialty medications in stock• Easy access to disease-focused teams• Assistance with prior authorizations• Coordinating medication refills• Links to patient assistance organizations• Insurance specialists to save your staff time and resources Triessent offers complete specialty pharmacy management, which includes safe and efficient delivery of specialty med-ications, guidance and education from experienced professionals, and integrated medical and pharmacy benefits man-agement.
Federal Employee Program (FEP) highlights
We value your participation in the Blue Cross and Blue Shield Service Benefit Plan for federal employees. FEP offers
two plans, Standard Option and Basic Option, through BCBSNM and other participating Blue Cross and Blue Shield
Plans nationwide.
The Standard Option offers benefits for covered services performed by both preferred and nonpreferred providers.
PPO benefits apply when the member uses a PPO preferred provider. If no PPO preferred provider is available, or the
member does not use a PPO preferred provider, non-PPO benefits apply. Out-of-pocket expenses, such as coinsurance
and copayments, are lower when members use preferred providers.
The Basic Option is a network-only benefit program that requires the member to use preferred providers in order to
receive benefits, except in emergency situations. This option offers a lower premium than the Standard Option and
comprehensive coverage with no deductibles or referrals. There is no coverage when a Basic Option member uses a
non-PPO provider. The Basic Option plan has different copays for PPO primary care providers and specialists.
The following benefits are available for FEP: • Hearing aids, including bone-anchored hearing aids, for children up to age 22, and bone-anchored hearing aids for adults when medically necessary due to traumatic injury or malformation of the external or middle ear.
Benefits for these hearing aids are limited to $1,000 per ear per calendar year.
• Office visits and diagnostic tests related to the treatment of morbid obesity. (Previously, benefits were not available for these services.) • Inpatient and outpatient hospital care related to the treatment of children up to age 22 with severe dental caries.
• Home hospice pre-enrollment visits when provided by a physician employed by the hospice agency.
(Previously, benefits were not available for these services.) • Ambulance transportation paid in full after a $50 per day copayment.
• Medically necessary emergency care provided at the scene when ambulance transport is not required.
For additional information on both options, visit the FEP website at fepblue.org.
BLUE Review
Issue 6 - 2008
We are here to help you
In each issue we profile employees of Provider Network there is truly a sense of family. Everyone works together Management, the Provider Service Unit (PSU), or the so well and really supports each other." Provider Access and Servicing Strategy (PASS) group,briefly describing what they do for you, the provider.
"Working withproviders is always This issue features three of our Contract Representatives: interesting. It can be Michelle Quintero, Jill Billingsley, and Joann Ireland.
difficult at times, but Network Services assigns contractors by contract type that challenge makes and region. We have ancillary, hospital, and government it all worthwhile.
contractors in addition to each regional contractor. Once I achieve a res-olution to their issues The contractors coordinate contracts and contract mat- or complete a negoti- ters. They are supported by lead provider representatives ation, I really get a who coordinate contracts with standard pricing and sense of accomplish- assist with provider site visits, orientations, etc. Call the ment. Keeping it a general department phone number at (505) 837-8800
win-win situation for or 800-567-8540, or go to bcbsnm.com/contact to con-
both the provider and BCBSNM is my main goal." tact a specific contractor or representative.
Joann Ireland, the Northwest Region contractor, has
Michelle Quintero has been in Network Services for the
worked for BCBSNM for 12 years. Before coming to 10 years that she has Network Services four years ago, she worked in the worked for BCBSNM.
Provider Service Unit. She brought her experience and Michelle is the Central Region contractor, serv- ing Bernalillo and Sandoval counties. She says that in her depart- ment, "We have different service represen- jobs, but we all strive for the success of the depart- ment and the provider community we serve.
What I like best about our providers is their passion for providing quality care "Even though we are part of a larger corporation, Health to our members." Care Service Corporation (HCSC), and benefit frombeing a part of a larger, economically sound entity," Michelle recommended that providers check Joann says, "we have a smaller workforce in New bcbsnm.com first for forms and information. "There is so
Mexico. Using the resources available to us through much information available such as the Blues Provider HCSC, we are able to improve how we work with all Reference Manual, pharmacy information, Medical our customers, internal and external, while retaining a Policies, and downloadable forms. This, along with links family atmosphere." to Availity® and other programs, will help answer yourquestions. If you don't find what you're looking for, we "It is important for our providers to know that are always happy to help." BCBSNM is committed to them and the community,"she continued. "Our mission is to promote the healthand wellness of our members and communities through Jill Billingsley is the Southwest Region contractor. Jill
accessible, cost-effective, quality health care. We cannot has been with BCBSNM for almost eight years. She do this without our network of providers." enjoys working for BCBSNM because "it's an incrediblecompany. I'm so appreciative of the opportunities I'vebeen given. I love working in Network Services because BLUE Review
Issue 6 - 2008
New wellness resources for your office
BCBSNM encourages our members to take an active role in managing their health. Our library of online tools and
workplace resources are available to help educate members on healthy lifestyle choices and setting goals to make
improvements.
Recent additions to boost interest in wellness include posters and pads of information about weight control and smok-ing cessation. Designed to be displayed in your office, the posters offer quick, memorable tips, and the pads includetake-away pointers. Both items are available in English and Spanish.
Your Network Management Representative has a supply of these new wellness resources and may be stopping by to
leave some with you. You may also call 800-567-8540 to request copies for your office. Thank you for your participa-
tion in this initiative on behalf of your patients and our members.
Electronic funds transfer holiday schedule
Providers may receive electronic funds transfer (EFT), transmit electronic media claims (EMC), and retrieve payment
reports at almost any time during the year. However, Health Care Service Corporation (HCSC) and legal banking
holidays can delay EFT and claims processing. Following is the schedule for EFT, system, and payment report avail-
ability for the remaining 2008 holidays through January 2009.
HCSC holiday
Legal banking holiday
Martin Luther King, Jr. Day EFT payment schedule:
Claims processed
File sent to bank
EFT payment available
Electronic data interchange (EDI) system and report availability schedule:
Claims Received
Date Reports
HCSC will be closed on Holiday Observed days. Claims received during the holidays will be processed the followingbusiness day. Payment reports, such as electronic admittance advice (ERA) and electronic payment summary (EPS),for claims processed on a business day following the holiday will be available for retrieval the next business day.
Regular hours:
rEDI-link Blue System: Available 24/7.
Note: Customers will receive EMC real-time reports on the day of transmission. For Availity's holiday schedule, please
visit availity.com or call 800-AVAILITY (282-4548).
BLUE Review
Issue 6 - 2008
P.O. Box 27630Albuquerque, NM 87125-7630 , an Independent Licensee of the Blue Cross and Blue Shield Association vice Corporation, a Mutual Legal Reser A Division of Health Care Ser Electronic funds transfer holiday schedule New wellness resources for your office are here to help you Federal Employee Program highlights riessent is new Specialty Phar reader sur
Requesting appeals on a member' Blue Review
Blues Provider Reference Manual 2009 Provider network additions Not yet contracted for Blue Medicare PPO? Blue Medicare PPO provider por t forget your CLIA number when billing for lab work lue Medicare PPO Corner:
Network Management contacts, related ser or visit the provider area on our website and Claims inquiries? Call the PSU please e-mail us at OFFICE Staff, continued:
on how we can improve this newsletter ms you need at bcbsnm.com Find the for Expediting paper claims processing If you have ideas for ar our views are impor Drug List updates members of our provider ve you as valued Medical Policy updates is your newsletter program for BludSalud members BCBSNM welcomes Medicaid program staff Have an idea?
going paperless in 2009 Issue 6 - 2008
BLUE Review
Diabetes ResourcesPractical Information for New MexicoHealth Care Professionals Albuquerque, NM 87190 A quarterly publication for clinicians caring for people with diabetes - Vol 9 No. 16, 2008
(866) 796-9121(505) 796-9121 Retinal Exams a Must In each issue of DiabetesResources we provide information aboutmanagement of diabetes for Diabetic retinopathy remains the leading cause of health care providers. blindness in adults. People with diabetes are 25 more likely to become blind.
Our publications support the d speciall eyee exam New Mexico Diabetes Practice Diabetic eye disease is preventable. Up to 90 percent h diabetess iss aa criticall part Guideline by providing of diabetes-related blindness could be prevented by g caree off yourr diabetes.
specific tools and resources appropriate screening and treatment.1 h diabetess should for providers to help reduce thiss speciall eyee exam the complications associated Two physician-driven interventions can substantially with diabetes. The ABCs of reduce the risk or progression of retinopathy: treating — Alfredo Vigil, MD diabetes is a reminder to test high blood pressure to goal (<130/80) and reducing Secretary, New Mexico patients 2 to 4 times per year A1C to goal (<7.0%).
for A1C, check Blood pressure Department of Health at each visit and test Standard prophylactic aspirin therapy that is now Cholesterol levels annually.
recommended for most people with diabetes does not The Diabetes Resources increase the risk of retinal hemorrhage.
address other clinicalrecommendations. Dilated The Current Clinical Recommendation: eye exam, foot exam andkidney disease screening as w Mexicoo Health h Caree Takess Onn Diabetess Practicee Guideline 2008 recommends that all people well as nutrition and physical with diabetes have a dilated retinal examination by an ophthalmologist or qualified optometrist activities are additional covered topics.
New Mexico's Numbers: In support of the New MexicoDiabetes Practice Guideline Blue Cross and Blue Shield of New Mexico/HMO New Mexico, Molina Healthcare of New 2008, please see the reverse Mexico, Lovelace Health Plan, and Presbyterian Health Plan agreed to pool their data to get a side of Diabetes Resources snapshot of how New Mexico is doing. Together, these plans provide health care for nearly 791,000 for tools and resources that New Mexicans.
can help in your efforts toprovide education and Percentagee off Peoplee with h Diabetess Whoo Receivedd aa Dilatedd Retinall Exam m inn 2001 1 andd 20072-5 support to your patients with 20012007National Check www.nmtod.com for
organizations that have graciously 69.1% 62.3%
51.3% 57.0%
47.4% 49.0%
provided funding for Diabetes
Indian Health Service (Albuquerque Area) New Mexico Health Care Takes OnDiabetes, a New Mexico non-profit 1 Diabetes: A Serious Public Health Problem At a Glance 2003. Department of Health and Human Services, Centers for Disease Control corporation, is a broad coalition of New Mexico's diabetes care profes- 2 Data reported using nationally validated HEDIS® methodology. Rates derived from meeting continuous enrollment requirements.
HEDIS is a registered trademark of the National Committee for Quality Assurance (NCQA).
sionals, New Mexico Health Plans, 3 HEDIS 2007 data for CY 2006 provided by BCBSNM, Molina Healthcare of New Mexico, Lovelace Sandia Health Systems and the New Mexico Department of Presbyterian Health Plan.
Health, and the New Mexico Medical 4 Indian Health Service data were provided for the Albuquerque Area and based on Government Performance and Results Act (GPRA) Review Association, with technical indicators from 2006 fiscal year. and administrative support from the 5 National average data provided by Centers for Medicare & Medicaid Services (CMS) for CY 2006, Quality Compass for CY 2006 and American Diabetes Association. Indian Health Services for FY 2005.
2008 Blue Review reader survey
Help us make Blue Review more valuable to you. Please complete this survey and fax it to: Blue Review Editor,
505-816-5556. You may submit your survey anonymously, but if you provide your name and phone number, we'll
enter you in a drawing for a $50 American Express® gift card! You may also complete the survey at
bcbsnm.com: select Providers, then look for the electronic version of the survey under News and Updates.
Thank you for your time and interest.
Deadline: Friday, December 19, 2008
1. We mail six issues of Blue Review per year. How many
issues per year do you at least scan to see if there is
Health status of BCBSNM members Y content of interest to you?
as reported by HEDIS® rates Office Staff section (filing and coding Y 2. How much of each issue of Blue Review do you read?
claims, Network Services contact All ❑ Most ❑ Some ❑ Very Little ❑ None Blue Medicare PPOSM 3. Please rate the design and layout of Blue Review –
how easy it is to get the information you need?
Prior authorization ❑ Excellent ❑ Very Good ❑ Average ❑ Fair ❑ Poor Our website, bcbsnm.com If "Fair" or "Poor," how could it be improved?
Any comments on the above topics?
4. Please rate Blue Review overall.
❑ Excellent ❑ Very Good ❑ Average ❑ Fair ❑ Poor 5. Do you receive provider-oriented newsletters from
other health plans?
7. What topics would be most useful for you in future
issues of Blue Review?
If "Yes," how does Blue Review compare to them?
❑ Better ❑ About the same ❑ Worse Please explain: 8. Which best describes your practice or facility?
❑ Radiology center 6. The following topics have appeared in Blue Review.
Please rate how useful and interesting the information
provided in each topic is to you. If you do not recall
❑ Outpatient surgery center seeing the topic, please leave the item blank.
9. Who completed this survey?
❑ Office manager Clinical practice guidelines for diabetes, asthma, hypertension, ❑ Physician assistant/ and hyperlipidemia Nurse practitioner Annual preventive health guide- lines for children and adults Practical resource publications from New Mexico Health Care If you have additional comments, please
Takes on Diabetes add them to your fax cover sheet.
Information on Disease Manage- ment Programs (Blue Care Connection®)

Source: http://www.bcbsnm.com/pdf/newsletters/blue_review_6_08.pdf