PLEASE NOTE: This page is for archival reference as our newsfeed has moved. For the latest news and updates, CLICK HERE to visit Provider News.
Blue Bulletin
Highmark Blue Cross Blue Shield of Western New York strives to provide our network of provider practices and facilities with the most current health plan information in a quick and easily accessible manner.
Search Results
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Updated Drug Therapy Guidelines Available Online - October 2022
October 28, 2022
Drug Therapy Guidelines were recently updated for your patients on both the Highmark and legacy systems. Twenty-three (23) drug therapy guidelines were added or updated recently by a committee that includes local physicians, other prescribers, and pharmacists. Highmark’s recently reviewed and approved drug policy guidelines are now available through the Highmark Provider Resource Center.
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Medical Protocol Updates Available Online – October 2022
October 28, 2022
We recently reviewed 57 medical protocols. These will be posted online on or before November 1, 2022, and will have an effective date of December 1, 2022, unless otherwise noted. Highmark’s monthly Medical Policy Update Newsletter will be available online on or before October 31.
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Process and Authorization Requirement Changes Coming for MSK Procedures and Pain Management, Molecular and Genomic Testing and Radiation Oncology
October 10, 2022
Effective January 1, 2023, Highmark Blue Cross Blue Shield of Western New York is making changes to our preauthorization requirements for some musculoskeletal (MSK) procedures and interventional pain management, molecular and genomic testing, and radiation oncology. New and continuing authorization requirements for these types of services will be managed by eviCore.
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Provider Resource Center to Replace Legacy Provider Website on February 1, 2023
September 22, 2022
Beginning on February 1, 2023, we will be redirecting those visiting our legacy provider website (bcbswny.com/provider) to the Highmark Provider Resource Center (PRC). The timing of this transition will occur after all Highmark BCBSWNY patients have been moved onto Highmark’s system in January 2023. In this article, you can learn more about this change and how to access important resources on the PRC.
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New Phone Self-Service Tools
September 22, 2022
To help reduce Provider Service call wait times, we’ve introduced new self-service phone tools. When you call Provider Service at 1-800-950-0051, you will hear new voice prompts to help you access patient information, including claims status, eligibility, and benefits without speaking to a representative.
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Virtual CME Opportunities
September 22, 2022
As you consider how to complete required Continuing Medical Education (CME) before the end of the year, we are happy to offer some new CME opportunities. You can earn up to 6 CME credits online at no cost through Highmark’s Population Health University and Coding and Quality Knowledge College. In this article, you can register for online modules, as well as an October webinar.
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2023 Vatica Incentive Payment Changes
September 22, 2022
Starting January 1, 2023, incentive payments for Vatica Annual Wellness Visits (AWV) will be paid directly from Vatica Health. Payments will be made monthly. This change creates a more streamlined process and eliminates the possibility of incentive payment discrepancies. Here, you can access updated billing grids and view coding guidance.
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Utilization Management: Coverage and Denial Processes
September 22, 2022
Understanding coverage and denial decisions and knowing the right steps to take after an authorization is denied will help your patient get the right care at the right time. This article provides further guidance on the appeal process after an authorization denial.
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Highmark Medical Policy Updates
September 22, 2022
Highmark’s monthly Medical Policy Update Newsletter will be available online on or before September 26.
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2023 Preventive Coverage Changes
September 16, 2022
Beginning January 1, 2023, we will be aligning with Highmark’s preventive services schedule determined by the USPSTF, AAP Bright Futures, HRSA Women’s Preventive Health, CDC General Immunization Schedule, and CMS Preventive Schedule. This means some labs previously considered preventive with a $0 cost-share for your Highmark Blue Cross Blue Shield of Western New York Commercial and Medicare Advantage patients will now be subject to your patients’ regular cost-shares and deductibles only when the lab is billed with a medical diagnosis.
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