Skip to main content

New Apex Network to Debut January 2021

Date:
September 24, 2020

BlueCross BlueShield of Western New York is offering a new plan to small groups for January 2021 that will include a network of high-performing provider practices. Only small groups (1-100 members) in Erie and Niagara Counties will have the option to choose Apex.

The network will be limited to only the highest performing primary care physicians (PCPs) and specialty groups who practice in those same counties. Not all specialty groups will be limited, in order to ensure that patients have adequate access to a variety of providers.

The limited network includes:

  • Top 40% of Erie and Niagara County primary care network groups (based on quality and efficiency, as measured in BestPractice)
  • Top 90% of all Erie and Niagara County specialty groups (based on Cave Consulting Group analytics)  

Providers will receive a contract amendment to Attachment A of our standard provider agreement by December 1, 2020. The amended Attachment A will indicate whether a provider is included in the Apex network. 

Cave analytics

Cave Consulting Group is an independent company focused on improving effectiveness (quality-of-care) and efficiency (cost-of-care) in the health care delivery system. Health plans throughout the nation use their comprehensive analytical tools to generate practice-level reports. Cave produces reports that analyze our claims data to provide a better understanding of area specialty provider quality and cost.

Please contact Provider Service at 1-800-951-0051 or (716) 884-3461 for more information.

Recent Articles

  • Improving Patient Satisfaction with CAHPS and HOS Surveys
    The Consumer Assessment of Healthcare Providers and Systems (CAHPS) and Medicare Health Outcomes Survey (HOS) are patient surveys that affect CMS star ratings – for you and for us. Improving patient experience leads to better health outcomes for your patients and helps support gap closure programs. In this article, you can find tips to help your office improve patient satisfaction, as well as additional information about these surveys.
  • Reminder: Working with BetterDoctor
    Highmark Blue Cross Blue Shield of Western New York partnered with BetterDoctor in 2020 to help keep our network provider information current. As part of our network, you can expect to receive emails from BetterDoctor and should not hesitate to respond to their outreach.
  • Congratulations to New York State HPV Vaccination Honor Roll Award Winners
    We want to congratulate several provider offices for achieving superior youth human papillomavirus (HPV) vaccination completion rates in their practice. Despite strong education efforts, youth HPV vaccination rates continue to remain low. According to the NYS HPV Coalition, at least 30% of adolescents in New York State are not fully vaccinated against HPV. Here, you can view the winners and find additional information about HPV vaccination.
  • Diabetes Prevention Program for Medicare Advantage Patients - 2022
    As a reminder, Western New York Integrated Care Collaborative (WNYICC) offers the Medicare Diabetes Prevention Program (M-DPP) to help your Highmark Blue Cross Blue Shield of Western New York Medicare Advantage patients with prediabetes manage their condition. This evidence-based, CDC-recognized program helps educate and offer support for older adults diagnosed with prediabetes or who are at high risk for developing Type 2 diabetes. In this article, you can learn more about the program and refer your eligible patients.
  • Medical Protocol Updates Available Online – July 2022
    Highmark’s monthly Medical Policy Update Newsletter will be available online on or before July 25.

Working with Us

Additional Resources

We want to hear from you! Have a topic request for the next Blue Bulletin? Email us

Stay in Touch! Sign up to receive emails for provider news and information