Under Provider Sign In, enter your username and password if registered, or select register now. Enter your CAQH Provider ID. (If you don't know it, call CAQH at 1-888-599-1771). Enter or update your information. Authorize Highmark BCBSWNY to access your information electronically.eviCore has a dedicated webpage for Highmark providers to conveniently access evidence-based clinical guidelines, the current CPT code list, important resources and recent announcements. We encourage you to visit their site to ensure that you have the most current information. Reference Materials. Lab Management Program Admin Guide.Annual Update to Highmark's Professional Fee Schedule & Pricing Methodology. 5/14/2024.Behavioral Health: 833-581-1866. Gastric Surgery: 833-619-5745. Durable Medical Equipment/Medical Injectable Drugs/Outpatient Procedures: 833-619-5745. Inpatient Clinical: 833-581-1868. Telephone: For inquiries that cannot be handled via the online provider portal, call the appropriate Clinical Services number, which can be found here.Highmark’s Provider Resource Center (PRC): You are here! The PRC is the main hub for you and your staff to review important information and tools, such as …Under Provider Sign In, enter your username and password if registered, or select register now. Enter your CAQH Provider ID. (If you don't know it, call CAQH at 1-888-599-1771). Enter or update your information. Authorize Highmark BCBSWNY to access your information electronically.Highmark regularly issues new or updated reimbursement policies. Keep an eye on this newsletter and the Provider Resource Center (PRC) homepage for …In 2.6 NAIC Codes, New York state information was added, including NAIC Code 55204, as well as claim submission procedures for Empire/Anthem and Excellus members when treated by Highmark providers. Chapter 6, Unit 1: General Claim Submission Guidelines. In 6.1 Timely Filing Requirements, the NEW YORK TIMELY FILING POLICY section was updated.The full fee schedule is available on the Provider Resource Center. Access by signing into Availity > Payer Spaces > Highmark > Provider Resource Center. Attachment size currently allows for a total 45MB for 1 – 10 attachments. Allow for attachment total size of 100MB for 1 – 10 attachments.July 11, 2024. 12:00 – 1:00 p.m. Highmark Wholecare's Financial Investigations and Provider Review (FIPR) Division will be hosting a live provider …Tool and Resources - The Provider Resource Center (PRC) is the central location for helpful information such as: The Highmark Provider Manual. BlueCard (Chapter 2, Unit 6) Fraud Prevention (Chapter 6, Unit 8) Important Announcements and Updates. Prior Authorization Requirements.The full fee schedule is available on the Provider Resource Center. Access by signing into Availity > Payer Spaces > Highmark > Provider Resource Center. Attachment size currently allows for a total 45MB for 1 - 10 attachments. Allow for attachment total size of 100MB for 1 - 10 attachments.A1: For retrospective review requests submitted on or after December 4, 2023, providers are encouraged to utilize the Provider Portal (Availity). If the request falls outside of the Provider Portal acceptance threshold, providers can contact Utilization Management at 1-800-452-8507.First Priority Health, First Priority Life or Highmark Senior Health Company. Central and Southeastern PA: Highmark Inc. d/b/a Highmark Blue Shield, Highmark Benefits Group Inc., Highmark Health Insurance Company, Highmark Choice Company or Highmark Senior Health Company. Delaware: Highmark BCBSD Inc. d/b/a Highmark Blue Cross …Obtaining Authorizations. Highmark requires authorization of certain services, procedures, inpatient level of care for elective/planned surgeries, and/or …Provider Information Management forms are used to maintain provider accounts as well as begin the process to join Highmark's networks for new practitioners and offices. Practice information updates can be made with many of the forms below. Please carefully read and follow the instructions contained within the individual form for …Provider Directory. Site Map. Legal Information. The following entities, which serve the noted regions, are independent licensees of the Blue Cross Blue Shield Association: Western and Northeastern PA: Highmark Inc. d/b/a Highmark Blue Cross Blue Shield, Highmark Choice Company, Highmark Health Insurance Company, Highmark Coverage Advantage Inc ...For 2023, Highmark's Preventive Health Guidelines feature these changes: Nutritional counseling for Obesity Prevention in midlife women, ages 40 to 60 years old, with normal body mass index (BMI) and overweight BMI. Explanation: Women's Preventive Services Initiative recommends counseling midlife women with normal or overweight BMI (18.5-29 ...2024 Preventive Health Guidelines. Prenatal/Perinatal Guidelines. Children Ages 0-6 Guidelines. Children Ages 7-18 Guidelines. Adult Ages 19-64 Guidelines. Adult 65 and Older Guidelines. Women's Preventive Health Services Addendum. Perinatal Depression Prevention Counseling Coding Guidelines. PrEP Related Services Coding Guidelines.The program will serve as a foundational value-based reimbursement program for Highmark’s Physical and Occupational Therapy provider networks. The program offers the potential for significant value-based reimbursement by rewarding participants for managing their Highmark member patient population toward high value (both quality and efficiency ...Behavioral Health Practice Resources. Behavioral Health-specific sample treatment records, sample policies, and sample office forms and protocols intended for use to assist in office site evaluations and treatment record documentation compliance. Sample Treatment Record Resources. Behavioral Health Progress Note. Behavioral Health Treatment Plan.To ensure delivery of emails from Highmark, please add the following email address, [email protected], to your address book. 1. Enter Email Address:*. (Enter Group/Vendor or Practitioner's e-mail address. The same e-mail address cannot be repeated for another Group/Vendor or Practitioner). Email Address: 2.Highmark Provider Manual ... Message Center. Manuals . Highmark Provider Manual; ... Western and Northeastern PA: Highmark Inc. d/b/a Highmark Blue Cross Blue Shield, Highmark Choice Company, Highmark Health Insurance Company, Highmark Coverage Advantage Inc., Highmark Benefits Group Inc., First Priority Health, First Priority Life or …Behavioral health. The Highmark BCBSWNY behavioral health provider network includes psychiatrists, psychologists, social workers, psychiatric nurses, and other mental health and employee assistance health care professionals. Our facility network includes hospital inpatient units, residential treatment centers, partial hospitalization programs ...To access Provider File Management: Log into Availity. Click on Payer Spaces and choose the appropriate Highmark plan (s) Scroll down and select Provider File Management under the Applications tab. You can also update your directory information by completing the appropriate forms on the Provider Resource Center.The full fee schedule is available on the Provider Resource Center. Access by signing into Availity > Payer Spaces > Highmark > Provider Resource Center. Attachment size currently allows for a total 45MB for 1 - 10 attachments. Allow for attachment total size of 100MB for 1 - 10 attachments.For more information about the Copay Armor program, contact the Highmark Provider Service Center for your service area. Free Market Health. Free Market Health is a new innovative specialty pharmacy model that aligns resources, risk, and accountabilities for pharmacy referrals and reimbursement. 5 Tips for Faxing Pharmacy Prior Auth Requests.Provider Resource Center. Authorization Requirements. Highmark requires authorization of certain services, procedures, and/or Durable Medical Equipment, Prosthetics, …The full fee schedule is available on the Provider Resource Center. Access by signing into Availity > Payer Spaces > Highmark > Provider Resource Center. Attachment size currently allows for a total 45MB for 1 - 10 attachments. Allow for attachment total size of 100MB for 1 - 10 attachments.Highmark will also post communications here on the Provider Resource Center, and Availity may announce new features and training opportunities on their in-portal message center. For Help. For Availity Client Services assistance, call 1-800-AVAILITY (282-4548) or, within the Availity portal, click Help & Training and then click on Availity Support.The benefits of providing both members and providers with the efficiency and safety of virtual health are here to stay. Virtual health services mean the use of synchronous or asynchronous telecommunications technology by a health care practitioner to provide health care services, including, but not limited to: Assessment. Diagnosis. Consultation.For our provider partners, True Performance reduces the complexity of multiple programs, offers a higher performance based reimbursement opportunity, and provides timely and actionable reporting. PCP entities with 250 or more members will be eligible to participate in the new program. Log in to NaviNet, then navigate to the Resource Center for ...But if you need to contact us, below are the telephone numbers exclusively for providers. HIGHMARK. 1-866-731-8080. Convenient self-service prompts available. 1-866-588-6967 — Freedom Blue SM PPO Provider Service Center. 1-866-675-8635 — Freedom Blue PFFS Provider Service Center. 1-866-634-6468 — Requests for Medical Management and Policy ...Highmark's Provider Resource Center. More information about the end-to-end authorization process, including workflow guides, may be found on our Provider Resource Center (PRC). Look under AUTHORIZATIONS > Procedures/Service Requiring Authorization. You will also find details regarding the Availity transition on the PRC.Introducing a new provider resource experience that simplifies getting you the information you need, when you need it. You're invited to visit an early release of our new site; try it out at providers.highmark.com.Your feedback is appreciated as we work to complete the experience.Highmark’s Provider Resource Center (PRC): You are here! The PRC is the main hub for you and your staff to review important information and tools, such as EFT registration, policies, procedures, and the Provider Manual. Availity Essentials, Highmark’s Provider Portal: The primary method to submit transactions to Highmark and access reports:Apr 18, 2023 · If you haven't already done so, follow these simple steps to get the most out of your Highmark Wholecare partnership. 1. Join our network by completing this form. (To Be Updated with Join Network URL) 2. Download your provider manual. 3. Login to the provider portal. 4.Organizational Credentialing Forms. Recredentialing Application for Facility and Ancillary Providers. If you have recently received a letter stating that you must recredential, please use this form to enter the requested information. Change of Ownership (CHOW) Form. Please use this form to report any changes in ownership which may include the ...The Medical Policy Department, in collaboration with physician specialists, develop and maintain medical necessity and coverage guidelines for all medical-surgical products for the Commercial and Medicare Advantage lines of business. These guidelines address medical services, including diagnostic and therapeutic procedures, injectable drugs ...The full fee schedule is available on the Provider Resource Center. Access by signing into Availity > Payer Spaces > Highmark > Provider Resource Center. Attachment size currently allows for a total 45MB for 1 – 10 attachments. Allow for attachment total size of 100MB for 1 – 10 attachments.Introducing a new provider resource experience that simplifies getting you the information you need, when you need it. You're invited to visit an early release of our new site; try it out at providers.highmark.com.Your feedback is appreciated as we work to complete the experience.This means you don’t have to retype data, such as NPI numbers or provider names. Access to Highmark-specific resources through a dedicated payer space. Which Highmark plans will I be able to access in Availity? Highmark Blue Shield (PA) Highmark Blue Cross Blue Shield (PA) Highmark Blue Cross Blue Shield (DE) Highmark Blue Cross Blue Shield (WV)Assistance for Highmark Participating Providers Impacted by Change Healthcare Cyber Event. 3/11/2024.Ordering Provider Access to RadMD - Physician Request for Prior Authorization. Pain Management (Injection) Quick Start Guide. Pain Management (Surgery) Quick Start Guide. Physical Medicine Program Quick Reference Guide. Physical Medicine Quick Start Guide. Physical Medicine Prior Authorization QRG. Physical Medicine Tip Sheet.1. Join our network by completing this form. (To Be Updated with Join Network URL) 2. Download your provider manual. 3. Login to the provider portal. 4. …Chapter 3, Unit 2: Professional Provider Credentialing. In 3.2 Highmark Network Credentialing Policy, the ADVANCED PRACTICE PROVIDER (APP) ENUMERATION section was updated to point providers to Reimbursement Policy 068 (RP-068): Mid-Level Practitioners and Advanced Practice Providers for more …For other important news, information, and updates from Highmark BSNENY, be sure to read Provider News. ... "Read","description":"\u003cp\u003e\u003cem\u003eBecause the Highmark Blue Shield of Northeastern New York Provider Resource Center site was not yet live on August 30th when this Medical Policy Update was distributed, we\u0027ve …For non-routine inquiries that require analysis and/or research, contact Highmark's Provider Service Center at the appropriate number for your region below. Highmark Provider Service Centers . DELAWARE: Highmark Blue Cross Blue Shield (DE): 800-346-6262 • Hours of Availability: 8:30 a.m. to 5 p.m. EST, Monday through FridayAvaility Essentials: Introduction for Highmark Providers. Applications covered: General Navigation, Eligibility and Benefits Inquiry, Manage My Organization, Payer Spaces, and Authorizations. ... As more information becomes available about the status of Risk Manager, we will share that with you via the Provider Resource Center and Availity portal.The full fee schedule is available on the Provider Resource Center. Access by signing into Availity > Payer Spaces > Highmark > Provider Resource Center. Attachment size currently allows for a total 45MB for 1 – 10 attachments. Allow for attachment total size of 100MB for 1 – 10 attachments.Home Health/Home Infusion Therapy/Hospice: 888-567-5703. Inpatient Clinical: 800-416-9195. Medical Injectable Drugs: 833-581-1861. Musculoskeletal (eviCore): 800-540-2406. Telephone: For inquiries that cannot be handled via the online provider portal, call the appropriate Clinical Services number, which can be found here.This information is issued on behalf of Highmark Blue Shield and its affiliated Blue companies, which are independent license es of the Blue Cross Blue Shield ... see Highmark Delaware's online Provider Resource Center and access the . Pharmacy Program/Formularies. link for details on the formularies and formulary options that apply toHighmark Blue Cross Blue Shield (WNY) recognizes that there are services you provide to many of our members outside of the typical office visit that you're currently not compensated for. To view information on our Best Practice reimbursement, please access the Provider Resource Center through the provider portal. Once you've reached the private ...Annual Update to Highmark’s Professional Fee Schedule & Pricing Methodology. 5/14/2024.Other than laws that regulate service providers, set minimum legal age and define the necessary elements for a valid contract, there is very little regulation in Florida centered a...The High Performing Provider (HPP) designation is replacing the former Pathways Program effective January 1, 2025, for providers in all Highmark service areas. It is designed to give Highmark a formal process and framework for identifying and rewarding high-performing providers based on a defined set of metrics, allowing qualifying providers to ...Tool and Resources – The Provider Resource Center (PRC) is the central location for helpful information such as: The Highmark Provider Manual. BlueCard (Chapter 2, Unit 6) Fraud Prevention (Chapter 6, Unit 8) Important Announcements and Updates. Prior Authorization Requirements.RP-026 Portable Radiography and ECG Services. A "Related Highmark Policies" section was added. RP-041 Services Not Separately Reimbursed. Codes 38204, 90889, 92605, 92606, 92618, 93740, and R0076 were added for Commercial products. These codes will be considered not separately reimbursed and rejected as non-billable to the member.But if you need to contact us, below are the telephone numbers exclusively for providers. HIGHMARK. 1-866-731-8080. Convenient self-service prompts available. 1-866-588-6967 — Freedom Blue SM PPO Provider Service Center. 1-866-675-8635 — Freedom Blue PFFS Provider Service Center. 1-866-634-6468 — Requests for Medical Management …First Priority Health, First Priority Life or Highmark Senior Health Company. Central and Southeastern PA: Highmark Inc. d/b/a Highmark Blue Shield, Highmark Benefits Group Inc., Highmark Health Insurance Company, Highmark Choice Company or Highmark Senior Health Company. Delaware: Highmark BCBSD Inc. d/b/a Highmark Blue Cross Blue Shield.Highmark retains the right to review and update its pharmacy policies at its sole discretion. These guidelines are the proprietary information of Highmark. Any sale, copying, or dissemination of the pharmacy policies is prohibited; however, limited copying of pharmacy policies is permitted for individual use. Highmark is a registered mark of ...Highmark Provider Manual. We have redesigned the Highmark Provider Manual to make it easier for you to view and find important information, policies, and procedures for all providers participating in our networks in Delaware, New York, Pennsylvania, and West Virginia. The Highmark Provider Manual is your primary reference guide to Highmark.The redesign of the Provider Resource Center is the next step in our continued improvement of self-service tools — tools that reduce administrative burden, ... All Highmark providers will have access to Availity on February 5, 2024. More information on the transition can be found in our special section on the Provider Resource Center.Provider Resource Center. Provider Portal Transition. Transition From NaviNet to Availity Starts October 2023. Highmark is replacing its existing provider portal, NaviNet ®, with …Step 1: Highmark Training. Step 2: Medicare Parts C and D General Compliance Training. Step 3: Combating Medicare Parts C and D Fraud, Waste and Abuse. Step 4: Training Attestation. Once you meet the program requirements, an authorized representative of your organization can complete and retain a copy of the attestation form above for your records.Provider Directory. Site Map. Legal Information. The following entities, which serve the noted regions, are independent licensees of the Blue Cross Blue Shield Association: Western and Northeastern PA: Highmark Inc. d/b/a Highmark Blue Cross Blue Shield, Highmark Choice Company, Highmark Health Insurance Company, Highmark Coverage Advantage Inc ...First Priority Health, First Priority Life or Highmark Senior Health Company. Central and Southeastern PA: Highmark Inc. d/b/a Highmark Blue Shield, Highmark Benefits Group Inc., Highmark Health Insurance Company, Highmark Choice Company or Highmark Senior Health Company. Delaware: Highmark BCBSD Inc. d/b/a Highmark Blue Cross Blue Shield.For more information on using the Service Facility Location field on claims, see the Highmark Provider Manual: Chapter 6, Unit 1: General Claim Submission Guidelines > Service Field Location. To access the Provider Manual, go to the Provider Resource Center, select MANUALS from the taskbar, and click HIGHMARK PROVIDER MANUAL from the dropdown.NOCD provides Highmark members with live one-on-one video therapy with exposure and response prevention (ERP)-trained therapists, access to a peer community, and a personalized self-management tool. Available to Commercial and ACA members in Delaware, New York, Pennsylvania, and West Virginia (age 5 or older). Alcohol use disorder.The benefits of providing both members and providers with the efficiency and safety of virtual health are here to stay. Virtual health services mean the use of synchronous or asynchronous telecommunications technology by a health care practitioner to provide health care services, including, but not limited to: Assessment. Diagnosis. Consultation.Availity Essentials: Introduction for Highmark Providers. Applications covered: General Navigation, Eligibility and Benefits Inquiry, Manage My Organization, Payer Spaces, and Authorizations. ... As more information becomes available about the status of Risk Manager, we will share that with you via the Provider Resource Center and Availity portal.Please call Provider Services if you would like to request more information about our 2024 Quality Program, QI/UM Work Plan, or summary evaluation of the 2023 QI/UM Program. You can also review Quality Program resources on our Highmark Wholecare Provider Resource Center. Medicaid: 1-800-392-1147 (TTY: 711)For Help. For Availity Client Services assistance, call. 1-800-AVAILITY (282-4548) or, within the Availity portal, click Help & Training and then click on Availity Support. We also have a special section on the Provider Resource Center that includes additional background information and Frequently Asked Questions.Behavioral health. The Highmark BCBSWNY behavioral health provider network includes psychiatrists, psychologists, social workers, psychiatric nurses, and other mental health and employee assistance health care professionals. Our facility network includes hospital inpatient units, residential treatment centers, partial hospitalization programs ...Annual Update to Highmark’s Professional Fee Schedule & Pricing Methodology. 5/14/2024.. Chapter 3, Unit 2: Professional Provider Credentialing. In 3.2 HigHighmark Wholecare providers are contractually requi Tool and Resources - The Provider Resource Center (PRC) is the central location for helpful information such as: The Highmark Provider Manual. BlueCard (Chapter 2, Unit 6) Fraud Prevention (Chapter 6, Unit 8) Important Announcements and Updates. Prior Authorization Requirements.Organizational Credentialing Forms. Recredentialing Application for Facility and Ancillary Providers. If you have recently received a letter stating that you must recredential, please use this form to enter the requested information. Change of Ownership (CHOW) Form. Please use this form to report any changes in ownership which may include the ... Availity Essentials: Introduction for Highmark Providers. Applicatio The Centers for Medicare and Medicaid Services (CMS) requires of Highmark and its network providers that current, accurate provider data is published in Highmark's Provider Directory. The Provider Directory is an important tool that helps our members contact practitioners, and the data itself is what drives timely and accurate claims processing. The Highmark Blue Shield Regulations for Par...
Continue Reading